Medical Biller

Under general direction submits claims. Follows-up on unpaid balances (insurance or patient), corrects errors, enters claim information, submits authorization/precertification requests with insurance companies, follows up on denied claims and/or authorizations, and submits appeals as necessary as a part of the revenue cycle team.

Job Responsibilities:

• Cross cover other areas in the office as assigned by management including Accounts Receivable/Denials, Customer Service or Authorizations.
• Perform billing tasks assigned by management which may include data entry, claim review, charge review, accounts receivable follow-up, or other related responsibilities.
• Provide input on system edits, processes, policies, and billing procedures to ensure maximization of revenues.
• Perform daily tasks in assigned work queues and according to manager assignments.
• Identify payer, provider credentialing, and/or coding issues and address them with management.
• Follow workflows provided in training classes and request additional training as needed.
• Utilize CBO Pathways as guide for determining actions needed to resolve unpaid or incorrectly paid claims and/or for authorizing procedures in assigned workqueue(s) using payer websites, billing system information and training within expected timeframe.
• Review reports to identify revenue opportunities and unpaid claims.
• Adhere to general practices and FGP guidelines on compliance issues and patient confidentiality.
• Communicate with providers, patients, coders, or other responsible persons to ensure that claims are correctly processed by third party payers.
• Work following operational policies and procedures, and regulatory requirements.
• Participate in workgroups and meetings. Attend all required training classes. Escalate issues to management as needed. Maintain confidentiality. Read and apply policies and procedures to make appropriate decisions. Coordinate functions and work cooperatively with others. Explain processes and procedures to others; performs other related duties as assigned.
• Responsible for assisting the professional billing staff within the CBO with difficult and escalated issues.
• Assist department supervisor on special projects and staff training.
• Appeal complex denials through review of payer policies, coding, contracts, and medical records. Utilize subject matter experts as needed.
• Make appropriate corrections to system to satisfy/edit payer requirements and re-submit claims as needed.

Patient Experience & Access

Serves as HEALTH HAVEN Brand Ambassador by upholding the HEALTH HAVEN Mission, vision and values and promoting excellence in the patient experience, during every encounter.

Drives consistency in every patient and colleague encounter by embodying the core principles of our HEALTH HAVEN Service Strategy CARES (Connect, Align, Respond, Ensure, and Sign-Off)

Greets patients warmly and professionally, stating name and role, and clearly communicates each step of the care/interaction as appropriate

Works collaboratively with colleagues and site management to ensure a positive experience and timely resolution for all patient interactions and inquiries whether in person, by phone or via electronic messaging.

Proactively anticipates patient needs, and participates in service recovery by applying the LEARN model (Listen, Empathize, Apologize, Resolve, Notify), and escalates to leadership as appropriate.

Shares ideas or any observed areas of opportunity, to improve patient experience and patient access, with appropriate leadership. (i.e. ways to optimize provider schedules, how to minimize delays, increase employee engagement, etc.)

Partners with Patient Access Center and Central Billing Office team members to support collaboration and promote a positive patient experience.

Takes a proactive approach in ensuring that practice staff are fully versed in the Access Agreement gold standard principles.

Minimum Qualifications:

To qualify you must have a High School Diploma or GED.

Experience in medical billing, accounts receivable, insurance, or related duties; Knowledge of CPT and ICD10; medical billing software; English usage, grammar and spelling; basic math;.

Light, accurate keyboarding skills required. Candidates must receive a score of 35 words per minute (wpm) or greater on the typing assessment that will be administered prior to onboarding.