JOB TITLE: Medical Certified Professional Biller
DEPARTMENT: Administration – Finance – Revenue Cycle Management
REPORTS TO: Director of Revenue Cycle Management
STATUS: Non-exempt
SUMMARY: Responsible for entering and coding patient services into computer system and ensuring encounters transfer properly for submission to insurance payers. Sorts and files paperwork, handles insurance claims, and performs collections/refund duties.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Collect, post, and manage patient account payments.
2. Submit claims to insurance payers.
3. Review delinquent accounts and call for collection purposes.
4. Collect unpaid claims and clear up discrepancies.
5. Process refund requests to patients and insurance payers.
6. Maintain strict patient confidentiality and information security.
7. Sort and file paperwork.
8. Ensure healthcare facilities are reimbursed for all procedures.
9. Handle information about patient treatment, diagnosis, and related procedures to ensure proper coding.
10. Know and understand several different coding systems, including ICD-10-CM, ICD-10-PCS, CPT, Level 1 HCPCS and Level 2 HCPCS.
11. Use computers / billing software to prepare and transmit claims.
12. Follow up to see if a claim is accepted or denied.
13. Investigate rejected claim to see why denial was issued.
14. Investigate insurance fraud and report if found.
15. Verify coverage and eligibility for medical services.
16. Communicate with medical providers, patients, and insurance payers.
17. Review patient accounts and correct any missing or inaccurate information.
18. Use billing software to prepare and transmit claims.
19. Investigate and appeal claims that were denied.
20. Complete data entry to update spreadsheets and reports.
21. Adapt to updates and changes in billing software.
22. Review patient information and translate services into correct codes.
23. Input medical data into patient account systems.
24. Assist with training Medical office staff on billing/coding updates.
SUPERVISORY RESPONSIBILITIES: This job has no direct reports.
#J-18808-Ljbffr