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Job Details Description
- This is an on-site position in our business office. ***
The Biller is responsible for billing of medical claims (UB04 and CMS 1500 forms) for reimbursement to various
healthcare payers. The primary focus for the Biller is to review the claim for accuracy and completeness prior to billing.
- Processes the majority of hospital related claims electronically. Will also be required to submit certain claims manually per provider. Ensures timely submission to the carrier for maximum reimbursement.
- Responsible for monitoring the daily download of claims from the HIS System to the Electronic Billing System. Reconciles the accounts daily from our HIS system to ensure all accounts are crossing over correctly. Also responsible for ensuring claims cross from Assurance to the payers electronically and if there is an issue to communicate this with Assurance.
- Accountable for reviewing, researching and resolving all billing edits in Assurance prior to submission of the claim in order to minimize denials.
- Bills secondary and tertiary claims identified from the Unbilled Report and Secondary to Medicare report in a timely manner. Bills Interim Accounts on a monthly basis.
- Responsible for the resolution of Medical Necessity denials by contacting the appropriate Registrar to obtain an additional diagnosis code from the physician’s office if available.
- Notifies Management of any billing delays or problems with the billing system immediately as well as reporting any payer issues.
- Responsible to identify edits/bridge routines needed in the Electronic Billing System. Works with the vendor to implement the edits/bridge routines in a timely manner. Places tickets with vendor when required.
- Communicates daily with various departments to obtain required information to successfully complete claims.
- Reviews and works daily report from the DNFB, such as the top 10 high balance claims and unreleased aging claims report.
- Prints and mails primary and secondary paper claims on a weekly basis.
Preferences
- Medical Billing and Coding Certificate preferred
- Experience with Assurance preferred
- This is an on-site position in our business office. ***
