Medical Biller

Position Title: Biller

Position Purpose: The Biller maximizes revenue by submitting accurate primary and secondary insurance claims according to regulatory agencies and payer guidelines; ensuring all implants and supplies are priced and billed accurately, following up on all pended accounts, ensuring contract amounts are correct for all charges entered and correcting rejected claims within electronic claims processing system.

Education, Experience, and Licensure:

Associate's Degree or equivalent from a two-year College or technical school; or one to three years' experience in a medical office, hospital, outpatient surgery center or related field; Computer experience, Excel, Word, Medical Billing Software and Applications; Working knowledge of Medical Terminology

Job Requirements:

A. Skills and Abilities:

1. Possess basic knowledge of medical terminology.

2. Possess knowledge of health insurance billing.

3. Possess knowledge of typing, word processing, spreadsheet and computer billing systems.

4. Possess accurate judgment, especially handling insurance claims and dealing with patient accounts.

5. Versatile and willing to coordinate with and participate in, when necessary, all other aspects of the Business Office.

6. Possess strong initiative to get daily work finished and processed.

7. Has ability to communicate effectively with patient, physicians and other staff members.

8. Is courteous, understanding and sympathetic toward patients, physicians and others.

9. Maintains regular attendance.

10. Ability to handle confidential information.

11. Ability to set priorities and work independently.

12. Ability to interact in a positive manner and to communicate well with patients, families, co-workers, supervisor and other facility employees.

13. Ability to handle multiple tasks.

14. Ability to enter data into computer, files large amounts of paper, and use office equipment.

15. Ability to use discretion in dealing with the public.

Implant/Supply Log:

1. Daily retrieve the implant/extraordinary supply information for previous days cases.

2. Pull invoices for implants and supplies and calculate mark-up pricing usin SCA Implant Calculator

3. Complete Implant Log spreadsheet and submit to eCoder daily

Daily Chart Prep:

1. Gather all charts using the previous days surgery schedule

2. Review all demographic and insurance information for previous days cases.

3. Initial/date insurance card copy as evidence accurate information review.

4. Review MSPQ form and verify that correct payer is set as primary insurance and the corresponding financial class is accurate for financial reporting

5. Identify signed ABN's as applicable for patient payment

6. Ensure an authorization number is recorded in the patient accounting system, if required by the payer

7. Ensure clinical logs are complete prior to billing

DSR Completion/Charge Entry:

1. Obtain the Daily Summary Report (DSR)

2. Pull all the unbilled Charts listed on the DSR

3. Ensure the authorization from the payer has the correct Codes listed on the DSR. Obtain a corrected authorization as needed.

4. Pended accounts - Enter a note in patients account if coding is not complete.

5. For all complete and ready to bill cases, input CPT/ICD9/HCPC information from DSR into patient accounting system.

6. Be sure to use correct transaction code for each account based on financial class.

7. Verify all contract amounts are populated, record total charge amount on DSR for balancing.

8. Sequence codes by contract allowable, highest allowable is first according to contract.

9. Complete a Charge Description Master (CDM) form for any code without a listed fee or for codes with a billed charge that is LESS than the contracted amount in the patient accounting system and submit to the Business Office Manager.

10. Balance accounting system reports to coding sheet before posting.

Billing/Claims Submission:

1. Claims will be sent ECS and/or Paper as required by payers.

2. Print UB/HCFA's as required for paper claims and submit to payer with required attachments.

3. Submit ECS claims to payers and fax attachments to payers, as required.

4. Resolve claim rejections by monitoring ECS reports daily.

5. Sends claim to secondary payer daily.

Pended/Incomplete Case Review:

1. Weekly, review pended case report and determine action needed to resolve.

2. Follow up on all cancelled cases to determine if eligible for charge.

3. Forward cancellation sheet to ecoder.

4. Preliminary CPT codes should be assinged to all pended accounts at month end and a notation made in the patients account.

B. Clinical Quality:

1. Communicates patient information to assure confidentiality and continuity of care

a. Documents all patient information according to established standards of care, policies and procedures

b. Discusses patient information with other health team members in an appropriate environment

2. Interacts with all patients, families, visitors and fellow employees in a mature, responsible manner to ensure a positive and professional facility environment

a. Displays a caring and responsive attitude and conducts all activities respecting patient, family and employee rights and expectations

b. Maintains confidentiality of all facility and patient information as required by facility policy

3. Considers age specific needs in communication.

C. Teamwork/Accountability/Integrity:

1. Utilizes time effectively.

2. Follows established facility policies and procedures with regard to attendance.

a. Maintains attendance according to guidelines and policy established by facility.

b. Adheres to tardiness policy.

c. Provides notification for unscheduled absences or tardiness in accordance with established departmental procedures as noted by supervisor.

d. Requests scheduled time off according to procedure as noted by supervisor.

3. Completes all documentation to ensure the availability of accurate and up to date information in accordance with established standards.

4. Adheres to established facility safety requirements and procedures to ensure a safe working environment.

a. Demonstrates to competent usage of proper body mechanics in all activities.

b. Identifies potentially unsafe situations and notifies supervisor.