Behavioral Health And Substance Abuse Medical Biller

This is an in-person opportunity. 

Required Qualifications:

• High school diploma
• 3+ years of relevant medical billing and accounting experience
• Strong attention to detail, organization and professional customer service skills
• Proficiency with Microsoft Office applications and Medisoft billing software
• Coding certification
• Medical terminology and ICD / CPT coding
• Technical skills in the areas of EDI, systems analysis, and process flows
• Ability to multi-task and work well under pressure
• Knowledge of basic computer software and the ability to learn billing software and electronic medical records required

Preferred Qualifications:

• Technical experience in Quickbooks and Medisoft billing software
• Bachelors in accounting, finance, or healthcare administration

This position is responsible for managing all aspects of A/R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including local, state and federal regulations regarding billing and collection practices are followed, as well as with established internal policy and procedure. Candidate must possess strong leadership and excellent management ability as well as an extensive medical billing background.

Description:

• Self motivated, team player, with desire to be promoted in a growing medical management company
• Has a contagious and positive work ethic, inspires others, and models the behaviors of Genuine, Caring, and Friendly.
• Has responsibility for managing front end business operations.
• Demonstrates effective verbal and written communication that is clear, well-organized, and demonstrates an understanding of client needs.
• Through genuine and positive communication, makes each customer feel informed, understood, and important.
• An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments.
• Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals.
• Adherence to standards of business conduct and compliance.

Principal Duties and Responsibilities:

• Researches claim denials by assigned payer/s to determine reasons for denials correcting and reprocessing claims for payment in a timely manner.
• Meets or exceeds established performance targets (productivity and quality) established by business management.
• Initiates and follows-up on appeals recognizing the payer defined aging criteria.
• Exercises good judgment in escalating identified denial trends or root cause of denials to mitigate future denials, expedite the reprocessing of claims and maximize opportunities to enhance front end claim edits to facilitate first pass resolution.
• Review medical record documentation to identify services provided by clinicians as it pertains to claims that are being filed
• Verifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation (Biller)
• Performs corrections for client registration information that includes, but is not limited to, patient demographics and insurance information
• Responsible for working EDI claim rejections in a timely manner
• Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers or clients. Able to apply correctly to claims / fee billed (Collector)
• Processes incoming EOBs to ensure timely insurance filing or client billing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance
• Responsible for processing payments, adjustments and denials according to established guidelines.
• Responsible for reviewing insurance payer reimbursements for correct contractual allowable amounts
• Responsible for reporting payer payment and denial trends in a timely fashion
• Responsible for reconciling transactions to ensure that payments are balanced
• Responsible for reducing accounts receivables by accurately and thoroughly working accounts in accordance with established policy and procedures
• Responsible for keeping current with changes in their respective payer’s policies and procedures
• Identifies problems and root cause of problems related to billing and collections
• Assist with training materials and training staff members
• Responsible for identifying problems / trends in medical documentation and reporting them in a timely fashion
• Answers client and customer questions regarding billing and statements
• Prepare claims for encounters with complex progress note issues
• Participates with special assigned projects
• Performs all other duties as assigned