Physician Biller I (FT

Physician Biller I (FT)

Responsible for verification and data entry of patient demographics, insurance eligibility, and benefit verification. Calculates, communicates, and collects patient financial responsibility before, during, or after services are provided, as appropriate. Negotiates, processes, and follows up on payment plan agreements. Files insurance claims and works rejected or errored claims. Assists the CMP clinics as appropriate. This is an entry level physician billing position.

Job Specific

• Verify patient demographics and proper completion of all required patient registration forms, including accurate data entry into practice management system.
• Verify medical insurance eligibility and benefit coverage, including accurate data entry into the practice management system.
• Determine or calculate patient financial responsibility using all available tools (e.g., insurance patient estimators, internal calculation spreadsheets, insurance fee schedules, etc.).
• Screen clinic schedules for high balances and bad debt utilizing all available tools (e.g., Phreesia, practice management system, etc.) and attempt to collect prior to the scheduled appointment.
• Collect, process, post, and deposit patient payments, including working the prepay bucket in the practice management system.
• Set-up and process payment plan agreements and financial assistance applications, including delinquent payment follow-up.
• File professional claims daily. Reviews and corrects any claim rejections and edits, or forwards to the appropriate team member for correction, and resubmits rejected claims after correction.
• Review, print, and/or process patient statements in accordance with established timelines.
• Organize, process, and complete the deposit protocol daily, including data entry into the general ledger.
• Sort, transport, and deliver mail and interdepartmental mail throughout the hospital campus.
• Document all patient, insurance, or other communication in accordance with departmental policy.
• Assist the CMP clinics with check-in and check-out functions.
• Assist the CMP clinics with patient demographics, insurance eligibility, insurance benefit verification, and data entry.
• Provide excellent and professional customer service, at all times, to patients, staff, managers, and clinicians.
• Consult team members, supervisor, director, and other appropriate resources to resolve billing and collection questions and issues.
• Maintain a collaborative working relationship with clinic staff, managers, clinicians, and the coding department.
• Plan and participate in departmental meetings with clinic staff, managers, administrators, advanced practices providers, and physicians.

Education

• Once obtained, maintain professional certifications as required by the certifying organization.
• Remain current with most recent revisions of billing and collections standards and federal regulations to comply with all legal requirements regarding billing and collection practices.
• Actively participate in all required in-service education.

Hospital

Other Duties As Assigned:

• Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

Minimum Requirements

EDUCATIONAL REQUIREMENTS

Required:

High School diploma or equivalent

Preferred:

• Knowledge of health insurance (HMO, PPO, Medicare, Medicaid, etc.)
• Knowledge of insurance benefits terms (copay, deductible, coinsurance, etc.)
• Referral and authorization requirements
• Knowledge of medical anatomy and terminology
• Associates degree in a healthcare related field

EXPERIENCE

Preferred:
One year of current medical billing experience in a physician office/practice setting within the last three years.

SPECIAL

SKILLS AND ABILITIES

Required:

Able to work in a collaborative team environment; good mathematical, verbal and written communication skills; able to organize and complete work in a timely manner; basic proficiency in Microsoft Office
365 apps; basic proficiency using telephone, fax, and email.

Preferred:
Able to read, interpret, and communicate all parts of an explanation of benefits or electronic remittance advice; intermediate proficiency in Microsoft Office
365 apps.

LICENSURE / CERTIFICATION REQUIREMENTS

Preferred:
Certified Medical Reimbursement Specialist (CMRS) certification or an approved, equivalent certification.

COMPANY PROFILE

Citizens Medical Center is a not-for-profit, community hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 317-bed acute care hospital with over 1,200 employees. Voted "Best of the Best" hospital in Victoria for 14…