Job description

The Medical Billing Representative position bills insurance companies for all clinic claims and physician bills; pursues collection of all claims until payment is made by responsible parties; purses uncollected monies from insurance companies through zero balance audits; and performs other work associated with the billing and collection process.
Essential Functions

• Prepares and submits medical claims to third-party insurance carriers either electronically or by hard copy.
• Follows up with third-party insurance carriers and patients until claims are paid.
• Monitors claims for missing information and authorization/control numbers.
• Reviews accounts that are at a zero balance to analyze if money was left uncollected by clients. If under-collection is identified, files appeal to collect underpayment.
• May be called upon to serve as a representative in meetings and communications with clients and payers.
• Looked upon to serve as a lead in a specific billing area.
• Secures needed medical documentation required or requested by third party insurances.
• Processes rejections by either generating a letter of rejection to patient or correcting any billing error and resubmitting claims to third-party insurance carriers.
• Works with coders to ensure that correct diagnosis/procedures are reported to third party insurance carriers.
• Notify patients when claims have not been paid after time frames in established accounts receivable policy.
• Keeps updated on all billing and benefit changes for third-party insurance carriers.
• Knowledge of governmental billing regulation and guidelines.
• Ability to bill Inpatient and Outpatient governmental and commercial claims.
• Audit accounts to ensure that appropriate payments are paid by responsible parties.
• Posts third-party insurance remittance vouchers and all other forms of payment.
• Maintains confidentiality of all information.
• Completes work within authorized time to assure compliance with departmental standards, including meeting production and quality standards.
• Demonstrates knowledge of, and supports, both client’s and SCHCD's mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
• Performs other duties as required.

Competencies

• Athena experience preferred
• Stress Management/Composure
• Results Driven
• Technical Capacity
• Problem Solving/Analysis
• Customer/Client Focus
• Teamwork Orientation
• Collaboration Skills
• Time Management
• Communication Proficiency

Experience

• 2 years experience in the medical office billing environment required
• 5 years experience in the medical office billing environment preferred

Job Type: Full-time

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