Medical Office Insurance Biller Reports to:

Billing Manager Summary:

Coordinates charge entries and patient billings for the medical facility. Process and follow-up on insurance billing, review EOB remittance to verify proper reimbursement and make necessary adjustments.

Essential Duties and Responsibilities:

Duties and responsibilities include the following. Other duties and responsibilities may be assigned. Meets with providers and/or obtains coding for outside facilities. Keys the charges daily provided from outside facilities patient visits. Post out of the office encounters and creates claims. Accesses outside facility EMR sites, if applicable, and communicates with various outside facilities to obtain coding and filing information needed to complete claims. Follow-up with facility guarantors concerning balances and payments. Works insurance aging, 30,60, 90 and over. Claim follow-up on unresolved claims to collect payment as well as utilizing the websites for follow-up. Benchmark

•including checking 0-30-day claims for receipt by insurance carrier. Notifies billing manager for any patterns of nonpayment, i.e., codes with specific carriers, specialist specific claims with carriers, etc. Work denials communicate carrier performance as it relates to timely payment, appeals, processing denials and plans. Takes calls from and meets with patients concerning balances due, setting up payment plans and partnering with providers for payment approval if not paid in full or within payment/payment plan guidelines. Reviews patient status claims for secondary and tertiary insurances, checks for Medicare and/or Medicaid coverage if within applicable timeframe, selects correct status and responsibility. Assesses patient account balances and sends statements. Processes and move patient accounts to the appropriate collection status. Works independently with peers. Other assigned duties as requested.

Qualifications:

Requires at least one year of experience and working knowledge in medical office billing. Working with electronic medical records and billing system such as EPIC and e-Clinical works.

Competencies:

To perform the job successfully, an individual should demonstrate the following competencies:

Analytical:

Collects and researches data: Uses intuition and experience to complement data.

Design :

Demonstrates attention to detail. Problem solving

•Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Works well in group problem solving situations ; Uses reason even when dealing with emotional topics.

Technical Skills:

Strives to continuously build knowledge and skills.

Customer service:

Manages difficult or emotional customer situations; responds promptly to customer needs: Responds to request for service and assistance; Meets commitments.

Interpersonal Skill:

Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; Keeps emotions under control; remains open to other ideas and tries new things.

Oral communication:

Speaks clearly and persuasively in positive or negative situations; listens and get s clarification; responds well to questions; Participates in meetings.

Written Communication:

Writes clearly and informatively; Edits work for spelling and grammar: Presents numerical data effectively; Able to read and interpret written information.

Leadership:

Accepts feedback from others.

Quality Management :

Demonstrates accuracy and thoroughness.

Diversity:

Shows respect and sensitivity for cultural differences.

Ethics:

Treats people with respect; keep commitments; upholds organizational values.

Organizational Support :

Follows policies and procedures: Supports organization's goals and values; supports affirmative action and respects diversity.

Judgment:

Displays willingness to make decisions; exhibits sound accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision

•making process; Makes timely decisions. Motivation

•Demonstrates persistence and overcomes obstacles.

Planning/Organizing :

Prioritize and plans work activities; uses time efficiently.

Professionalism:

Approaches other in a tactful manner; reacts well under pressure; treats other with respect and consideration regardless of their status or position; accepts responsibility for own actions; follows through on commitments. Quality

•Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality.

Quantity:

Meets productivity standards; completes work in a timely manner; works quickly.

Safety and Security:

Observes safety and security procedures; reports on potentially unsafe conditions.

Adaptability:

Adapts to changes in the work environment. Attendance /Punctuality is consistently at work and on time; ensures work responsibilities area covered when absent; arrives at meetings and appointments on time.

Dependability:

Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commits to long hours of when necessary to reach goals. Completes task on time or notifies appropriate person with an alternate plan.

Initiative :

Asks for offers help when needed.

Innovation:

Displays original thinking and creativity; meets challenges with resourcefulness.

Qualifications :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Education and/or

Experience:

One-year certificate from college or technical school to six months related experience and/or training or equivalent combination of education and experience.

Language Skills:

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to patients and other employees of the organization.

Mathematical skills:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

Reasoning Ability :

Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

Computer skills:

To perform this job successfully, an individual should have knowledge of accounting /insurance billing software; Internet software and word processing software.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms and talk to hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and /or move vision, peripheral vision and ability to adjust focus.

REQUIREMENTS

We are a dedicated medical team of primary care , specialists, and nurse practitioners. We provide medical services at several healthcare facilities including our state-of-the-art office, local acute care hospitals, rehabilitation hospitals, long-term acute care facilities, and Louisiana nursing homes.