The Insurance Biller is responsible for billing (UB04 and 1500 forms), follow-up and accounts receivable activities for Insurance claims for Hospital and RHC. This position is part of Billing Services and includes insurance in the following classifications:

Medicare Medi-Cal Managed Medi-Cal Insurance Worker's Compensation Crossover Qualifications:

High School Diploma/GED. Computer experiences required. Experience in healthcare or medical related billing (UB04 and 1500) Knowledgeable in

CPT/HCPC

codes, diagnosis, medical terminology. Able to understand RAs and EOBs.

Job Requirements:

Billing all Insurance claims. This includes Hospital, Outpatient, Clinic and SNF claims, with daily focus on attaining productivity and quality standards. Electronic Billing Hardcopy Billing Monitor accounts receivable daily through collector work lists (ATB). Responsible for all accounts/follow-up for any claims with problems and making sure that they get processed. This includes analyzing, investigating and resolving unpaid claims and securing payment. Denial Management duties such as but not limited to corrections, resubmissions and confirmations. Works with HIM in requesting needed medical records. Maintains all documentation and records in accordance with federal, state and facility requirements. Works with Revenue Cycle Director and CFO during yearly audits in providing requested data and information. Responsible for monitoring publications to stay current with billing guidelines related to assigned insurance classifications. Responsible for reporting to the Revenue Cycle Director all issues related to insurance claims that have impact on timely reimbursement. Maintains assigned insurance classifications A/R at set goal for 90 days and older. Studer AIDET fundamentals are used for customer service (external and internal). Applies these fundamentals in answering questions and/or concerns for patients. Responsible to ensure no violation in privacy with patient information/care. Responsible with working with the public and assisting them with their bills. Ability to run reports from the follow-up list to the financial reports. Ability to read and analyze reports. Demonstrate effective communication with all members of the healthcare team to achieve desired outcomes and attend/participate in education, in-services, mandatory training and staff meetings per policy.