Summary:

The Medical Biller is responsible for preparing, reviewing, correcting, and updating insurance claims for submission to payers,

Typical Schedule:

Full Time, Monday through Friday, Days

Onsite training/onboarding will be required.

Qualifications:

Recent experience in hospital billing required. Critical Access and/or Rural Health Clinic experience a plus. Experience in charge capture, coding, revenue cycle management, patient accounting and/or physician billing a plus.

Experience with EPIC EMR preferred.

Medical Terminology preferred.

High School Diploma required.

Responsibilities include:

• Investigating & resolving claim denials

• Identifying denial patterns and managing insurance project resubmissions with multiple claims

• Validate denial code/reasons following explanation of benefit (EOB) review and ensure coding is accurate and reflects the procedures billed

• Analyze all coding adjustments made on EOB to ascertain accuracy and valid support

• Review Summary Plan Descriptions and related insurance documents to ascertain benefits

• Determine and execute best approach for denial resolution and processing appeal

• Ensure timeliness of all appeals according to Federal, State and plan guidelines

• Generate appeals based on the dispute reason(s)

• Document all actions taken during the appeal process and any follow-up required

• Request and obtain medical records, notes and/or copy of claim as appropriate

• Resolve appeal claims with third party payers

Knowledge, Skills & Abilities:

• Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements.

• Knowledge and use of payer medical policy and Medicare LCD/NCD criteria.

• Knowledge of billing and coding requirements

• Must have the ability to effectively utilize Microsoft Office

• Must possess excellent verbal, written and interpersonal communication skills, and able to balance multiple demands and respond to time constraints.

• Must have high-level skills in organization as well as problem solving and analytical skills.

• Capacity to manage time effectively, attention to details, and follow through.

• Well-developed research skills.

• Advanced technical skills to quickly learn hospital information systems

• Knowledge of contracting and credentialing implications on revenue cycle functions