Medical Billing/Business Office

Summary

Responsible for researching, correcting, updating erroneous or missing account information, insurance, guarantor or other medical information, vouchers, purchase orders, vendor statements. Performs accurate billing and appropriate reconciliation of charges in a timely manner; provides reports, documentation, and ongoing statistics as needed. Ensures cash/insurance payment posting activities are accurate and completed in a timely manner. Coordinates and manage day to day activity of centralized billing office personnel as directed by the practice manager

Responsibilities

- Process accounts for collections including researching the balance 
- Post payments from remits. Send any additional information they may need. Research of past due accounts - small balances received letter and given 10 days to pay
- Supports a patient first culture that fosters a high level of patient satisfaction.
- Update/verify demographics, responsible party designation; verify insurance eligibility and benefits coverage from all applicable insurance sources.
- Obtain pre-authorization/pre-certification as required.
- Contact or review insurance systems to determine claim status; balance due on previously billed accounts.  Resolve problems by phone, payers' website or written correspondence, including coordination of benefits payable from primary/secondary payer.  Draft appeals regarding claim denials, or improper payments and requests rebilling of accounts as needed.
- Obtains applicable insurance print-outs to determine eligibility level for existing insurance coverage.
- Updates patient accounts with appropriate insurance codes.
- Determines self-pay patient eligibility for alternative insurance/benefits e.g. Medicaid, VFC, Tots & Teens
- Establishes payment agreements with patients, where applicable, for bill payment and conducts follow-up/tracking of previous payment arrangement; Refers patients to collection agency if previously established payment agreements are defaulted.
- Responds to billing related inquire from patients.
- Accepts co-payments and make daily bank deposits
- Completes billing forms according to payer's requirements.  Create and submit claims and appeals within established time constraints either electronically or manually. Reviews billing reports (EOB/ERA) to ensure proper receipt of all claims, and documents records accordingly.
- Tracks and reconciles charges or payments received using automated files, manual charge records.
- Maintains current knowledge of third party claim provisions, stipulations, filing and appeals procedures, as applicable
- Enter physician charges into billing system. Review ICD/CPT codes and works with medical personnel to reconcile errors and inconsistencies.  Responds to billing related inquiries from patients and/or Patient Billing Services.
- Create check requisitions  and purchase orders, maintain associated file
- Coordinates, processes, and maintenances physician's credentialing records

Education:  High school graduate or equivalent with excellent communication and analytical skills. Two years of college in a business-related area preferred.

Experience: Three years’ experience in a medical billing/medical office or related field with an emphasis on financial/insurance related work (preferably in a medical setting) required.  Successful completion of medical terminology course and three years’ experience with current CPT/ICD coding preferred. Experience in communicating and relating to various people with diverse needs. Prior data entry experience preferred.