Billing and Collections Representative - San Antonio, TX

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)
 
The Biller/Collector position is an Accounts Receivable function.  To perform this job successfully, an individual must be able to perform each assigned essential duty satisfactorily. 
 
This position is expected to have excellent reasoning skills based on knowledge of clinic operations as it pertains to billing claims to Insurance Health Plans and coding for medical diagnosis and procedural coding. Individual should be familiar with the conventions and instructions provided within the ICD disease classifications and CPT coding guidelines. Should also be able to reason through insurance claims differences as defined by benefit and plan differences.
 
This position is responsible for resolution 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.
 
Primary Responsibilities:

Reviews medical record documentation to identify services provided by physicians and mid-level providers 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
Performs corrections for patient 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, Medicare, or patients.  Able to apply correctly to claims/ fee billed
Processes incoming EOBs to ensure timely insurance filing or patient 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 reconciling transactions to ensure that payments are balanced
Responsible for reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and procedures
Responsible for keeping current with changes in their respective payer’s policies and procedures
Communicates with the Clinics to provide or obtain corrected or additional data
Prepare documents for training or for establishing procedures for clinics
Answer patient and customer questions regarding billing and statements
Performs all other related duties as assigned

Required Qualifications:

High school diploma or GED equivalent
Two or more years of relevant experience in the healthcare industry, with a focus on medical terminology and ICD/CPT coding preferred
Strong attention to detail and professional customer service skills
At least an intermediate level with Microsoft Office applications
At least an intermediate level of data entry
Preferred Qualifications:

Technical skills in the areas of EDI, systems analysis and process flows
Coding certification
50wpm typing skill
Knowledge of submission and resubmission of medical claims
Knowledge of government and commercial policies and procedures
Knowledge of ICD, CPT codes and HCPCS coding
Knowledge of HIPAA compliance rules and regulations
Skill in the operation of billing software and office equipment
Skill in using Microsoft Office (Outlook, Excel, Word)
Skill in processing claims efficiently and on a timely basis
Solid customer service skills and excellent interpersonal skills
Attention to detail
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
 
Job Keywords: San Antonio, Texas, TX, Billing, collections, clerical, support, clerk,