Professional Medical Biller

JOB TITLE: Medical Certified Professional Biller

DEPARTMENT: Administration – Finance – Revenue Cycle Management

REPORTS TO: Director of Revenue Cycle Management

STATUS: Non-exempt

SUMMARY:

Responsible for entering and coding patient services into computer system and

ensuring encounters transfer properly for submission to insurance payers. Sorts and files paperwork,

handles insurance claims, and performs collections/refund duties.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Collect, post, and manage patient account payments.
• Submit claims to insurance payers.
• Review delinquent accounts and call for collection purposes.
• Collect unpaid claims and clear up discrepancies
• Process refund requests to patients and insurance payers.
• Maintain strict patient confidentiality and information security.
• Sort and file paperwork.
• Ensure healthcare facilities are reimbursed for all procedures.
• Handle information about patient treatment, diagnosis, and related procedures to ensure proper coding.
• Know and understand several different coding systems, including ICD-10-CM, ICD-10-PCS, CPT, Level 1 HCPCS and Level 2 HCPCS.
• Use computers / billing software to prepare and transmit claims.
• Follow up to see if a claim is accepted or denied.
• Investigate rejected claim to see why denial was issued.
• Investigate insurance fraud and report if found.
• Verify coverage and eligibility for medical services.
• Communicate with medical providers, patients, and insurance payers.
• Review patient accounts and correct any missing or inaccurate information.
• Use billing software to prepare and transmit claims.
• Investigate and appeal claims that were denied.
• Complete data entry to update spreadsheets and reports.
• Adapt to updates and changes in billing software.
• Review patient information and translate services into correct codes.
• Input medical data into patient account systems.
• Assist with training Medical office staff on billing/coding updates

SUPERVISORY RESPONSIBILITIES:

This job has no direct reports.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

The requirements listed below are representative of the knowledge, skill, and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the

essential functions.

REQUIRED SKILLS:

• Knowledgeable and experienced with Medical Terminology
• Multitask oriented, organizational and team skills
• Proficiency with computers, Microsoft Office 360 (Outlook, Word & Excel), Adobe and medical billing software
• Knowledge of unfair debt collection practices and insurance guidelines
• Understanding of primary code classifications: ICD-10-CM, ICD-10-PCS, CPT and HCPCS
• Communication skills with patients/healthcare companies
• Basic accounting and bookkeeping practices

EDUCATION AND/OR EXPERIENCE:

Certified Professional Biller (CPC) certificate in medical billing field or 3+ years related experience and/or

training; or equivalent combination of education and experience.

LANGUAGE SKILLS:

Ability to read and interpret documents such as safety rules, operating and maintenance instructions,

and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively

before groups of customers or employees of organization.

REASONING ABILITY:

Ability to solve practical problems and deal with a variety of concrete variables in situations where only

limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral,

diagram, or schedule form.

COMPUTER SKILLS:

To perform this job successfully, an individual should have the ability to gain knowledge of the Practice

Management System, NextGen software, Microsoft Office Suite, and Accounting software.

CERTIFICATES, LICENSES, REGISTRATIONS:

Medical Billing and Coding Certification

OTHER SKILLS, KNOWLEDGE AND ABILITIES:

Ability to speak Spanish helpful.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to

successfully perform the essential functions of this job. Reasonable accommodations may be made to

enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to stand; walk; use hands to

finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally

required to sit and stoop, kneel, crouch, or crawl. The employee must regularly lift and /or move up to

25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral

vision, depth perception and ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee

encounters while performing the essential functions of this job. Reasonable accommodations may be

made to enable individuals with disabilities to perform the essential functions. While performing the

duties of this Job, the employee is occasionally exposed to fumes or airborne particles, toxic or caustic

chemicals and risk of radiation. The noise level in the work environment is usually moderate.