Medical Biller – Hospital Claims

Medical Biller – Hospital Claims

Requirements

• High School Diploma / GED or 3 years of relevant equivalent experience in lieu of diploma / GED
• 0-2+ years working within the following sectors: healthcare, insurance, business, finance or customer service
• Working knowledge can be of the following: insurance claims, billing, coding, follow-up, finance, accounting or customer service related responsibilities.

Responsibilities

• Performs daily download and reconciliation of claims from patient accounting system to electronic billing system.
• Transmits or releases claims at a minimum daily.
• Works all assigned claims daily by resolving edits, validating claim, or placing on departmental hold by reason.
• Follows-up on all assigned held claims or unreleased claims.
• Bills claims via electronic billing system.
• Reviews same day and 72 hour admission report to determine if accounts needed to be combined.
• Ensures all address changes and or plan changes are forwarded to the appropriate people so the integrity of the insurance master is maintained.
• Files adjusted billings based on audits and or changes in diagnosis or DRG.
• Updates patient accounts with corrected demographic or insurance information.
• Works all rejection and payer audit reports within 48 hours of receipt taking whatever action may be required to obtain account resolution.
• Monitors all denials for trends and issues and reports finding to supervisor.
• Bills or re-bills as necessary.
• Ensures hospital is in compliance with all state and federal rules and regulations both billing and HIPAA.
• Assigned special projects will be completed within the time frames given.
• Appropriately documents electronic billing system and/or patient accounting system.
• Attends training sessions and seminars offered by the Hospital and Third Party Payers.
• Handles all customer calls both internal and external in a professional and courteous manner.
• Returns calls and emails as soon as possible, but must be returned within 24 hours.
• Follows the mission statement and values established by the facility.

Preferred Qualifications

• Previous billing background.
• Emphasis in Hospital Billing
• Excellent communication and interpersonal skills.
• Experience with Excel and Word.