Medical Biller

Summary/Objective
Under limited supervision the Medical Biller reviews and verifies medical bills and invoices with accounts receivable ledger and patients. Ensures record accuracy, follow up, and makes necessary revisions. The Medical Biller processes changes in system to support accurate and efficient billing processes. The Medical Biller will be charged with maintaining the confidentiality of patient records and procedures.

Essential Job Functions

Analyzes, investigates, and resolves account issues, including resubmitting and updating line and claim document information.

Accesses available resources to locate missing or incorrect information. Updates medical claims with corrected billing information and releases claims for transmission to the payer.

Investigates and documents actions taken to resolve medical billing discrepancies and unusual charges and credits.

Works high priority Third-Party Liability/MVA/WC cases according to department policies and procedures.

Conducts research to make the determination of related paid claims for subrogation cases, which includes identification and validation of TPL/MVA/WC claims cost avoidance.

Receives and responds to incoming correspondence and calls pertaining to TPL/MVA/WC verification, billing, and collections inquiries from various sources.

Evaluates case status based on established criteria and takes appropriate action to maintain productive and proactive communication with the third party.

Ensures that all appropriate patient service charges are entered into the billing system.

Ability to prioritize and multi-task in a fast-paced, changing environment.

Demonstrate ability to work in all work types and specialties.

Demonstrate ability to self-motivate, set goals, and meet deadlines.

Demonstrate leadership, mentoring, and interpersonal skills.

Demonstrate excellent presentation, verbal, and written communication skills.

Ability to develop and maintain relationships with key business partners by building personal credibility and trust.

Maintain courteous and professional working relationships with employees at all levels of the organization.

Demonstrate excellent analytical, critical thinking and problem-solving skills.

Skill in operating a personal computer and utilizing a variety of software applications.

Knowledge of coding convention and rules established by the AHIMA , American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes.

Knowledge of JCAHO, coding compliance and HIPAA HITECH standards affecting medical records and the impact on reimbursement and accreditation.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; and talk or hear. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus.

Position Type/Expected Hours of Work

This is a full-time position. Days and hours of work are generally Monday through Friday, 8:00 a.m. to 5 p.m. This position occasionally requires long hours and weekend work.

Travel

Minimal travel required; up to 5%

Required Education and Experience

Successful completion of an AAPC or AHIMA-approved Coding Certificate Program and a minimum of three to five years of medical billing and/or coding experience.…