Biller Governmental- Billing & Collections

Position: Biller Governmental- Billing & Collections- FT- Days
DHR Health - US:

TX:

Edinburg - Days

Summary:

FLSA STATUS: ☐ Exempt ☒ Non-Exempt

MISSION STATEMENT:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

VISION:

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

POSITION SUMMARY:

This position is responsible for preparing accurate and compliant claims to be billed to Medicare and Medicaid insurance companies either electronic or paper, or insurance web portals and correcting any billing claim errors prior to claims submission and must also ensure that claims billed do not exceed the timely filing limits and re-submit any claims as necessary.

POSITION EDUCATION/

QUALIFICATIONS:

• High School Diploma/GED is required
• One (1) year billing experience, or relevant education in Governmental claims filing required, hospital setting preferred.
• Basic computer skills are required.
• Knowledge of healthcare reimbursement is preferred
• Good written and verbal communication skills are required.
• Ability to read, write and speak English
• Ability to communicate clearly and concisely with all levels of Management

JOB KNOWLEDGE/

EXPERIENCE:

• Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
• Establishes and maintains long-term customer relationships, building rapport with other department staff
• Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is preferred
• Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
• Requires reasoning ability, good independent judgment and working with frequent interruptions.
• Medical Terminology, ICD-9, ICD-10 CPT Codes, HCPCS Codes, Diagnosis codes knowledge is preferred.
• Ability to use the internet to obtain information from Third Party Payers or other sources is required.

Responsibilities:

POSITION RESPONSIBILITES:

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Demonstrates proficiency in Governmental billing and follow up of Medicare and Medicaid rejected claims on-line or through billing software; as billed or adjusted online biller will ensure to mimic changes on a UB/HCFA 1500 copy on Relay (set to laser print)
• Ability to use the internet for FISS and TMHP access, and RTP location.
• Submits adjusted claims to Medicare through online automated system-FISS and or TMHP online
• Daily, works all identified billing edits through electronic billing system.
• Transmits all electronic claims to the billing vendor three times a day.
• References updated ICD-9-CM/ ICD-10-CM, CPT, Modifiers and HCPCS Level II code books as needed.
• Works and follows up on the electronic rejection reports by correcting the UB-04/HCFA 1500 and resubmitting the claims daily.
• Proficient in printing out UB/HCFA files daily; and UB distribution
• Proficient in creating and working Late Charge Report adjustments
• Works the non-transmitted report by researching the error and resubmitting the corrected claims daily.
• Works re-bills requested by follow up staff through the electronic billing system daily
• Works on editing and preparing Secondary/Tertiary claims for either electronic or paper submissions, to include all necessary primary EOBs and or MRANs
• Proficient in printing out UB/HCFA files daily; and UB distribution
• Ensures to bill all CSHCN claims via web-portal.
• Works the accepted and rejected reports from the billing vendor and documents on patient management in the appropriate account.
• Proficient in Interim Billing
• Communicates billing issues with the supervisor/manager immediately.
• Responsible to place claims under appropriate Billing hold for designated department to complete the requests of clarification on diagnosis, CPT , HCPCS, or Modifier, etc
• Responsible to complete Aeos BL's, RQ's on a daily basis
• Reviews late charges…