Medical Biller II

Medical Biller II  

Affiliate Wide

Essential Functions

• Reviews all Tasks assigned to the individual/workgroup. 
• Aggressively follows up on all unpaid accounts to ensure that the A/R benchmark targets are met or exceeded.  
• Answers patient calls and address questions related to insurance and patient responsibility. 
• Works in conjunction with other staff to successfully meet internal goals.  
• Performs all duties in accordance with established agency policies, protocol and the In This Together services ethos, workplace values, and service standards. 
• Notifies Billing Manager of any collection or workflow issues. 
• Shows respect to all internal and external customers for differences in backgrounds, lifestyles, viewpoints and needs 

Insurance Tasks:

• Runs assigned reports to review all unbilled patient transactions for accuracy and completeness of charges and appropriateness of coding, correcting errors as needed 
• Verifies Insurance coverage to make sure coverage is effective for the billable date(s), appropriate for the services provided and all policy details are entered accurately  
• Addresses any claim edits that occur prior to filing claims, or that are a result of creating claims 
• Files clean claims electronically and on paper when necessary, using the NextGen EPM system or any other practice management systems clients are utilizing, and various clearinghouse applications as applicable 
• Posts payments from insurance companies 
• Applies payments and adjustments accurately from the remittance 
• Reviews to make sure that the charges roll appropriately to the next responsible party 
• Makes eligible sliding fee adjustments 
• Makes sure the batch balances 
• Maintains awareness of contracted reimbursement rates, follows up on discrepancies and notifies supervisory when there are unresolved issues 
• Works rejected claims and denials received on remittances 
• Performs timely follow up on outstanding unpaid claims; resubmits or appeals claims as needed in accordance with payer requirements   

Patient Billing and Cash Application: 

• Works credit balances on a timely basis to ensure overpayments are addressed 
• Makes follow-up phone calls and sends past due letters on accounts with outstanding balances according to patient collections policies and procedures 
• Reviews accuracy of patient accounts prior to generating statements 
• Processes patient payments, returned checks, small balance write-offs and bad debt adjustments in accordance with established policies and procedures 

Other Accountability Activities

• Attends and participates in team meetings and other required meetings or training opportunities including education on insurance rules and regulations 
• Assists with training of other staff 
• Participates in affiliate initiatives 
• Performs other duties as assigned by the Billing Manager 
• Builds and maintains positive, quality relationships with customers, both internal and external 
• Adheres to PPCWNY safety and security rules, policies, and procedures and HIPAA confidentiality standards 

Qualifications

• Applicants must possess the following qualifications (or equivalent combination of education and experience):

Education

• Associate’s degree in business, accounting, business administration, or a related field or equivalent combination of education and experience 

Experience

• Minimum three years of experience in medical billing/collections 
• Minimum three years of experience with computerized billing/receivables system and reports 
• Experience with NextGen practice management system preferred 

Certifications

• Ideal candidate will have one of the following certifications but is not required:  Registered Health Information Administrator (RHIA), Certified Health Information Technician (CHIT), Certified Coding Specialist (CCS), Certified Medical Billing Specialist (CMBS), or Certified Professional Coder (CPC) 

Knowledge, Skills, & Abilities

• Minimum three years of experience in medical billing/collections 
• Minimum three years of experience with computerized billing/receivables system and reports 
• Experience with NextGen practice management system preferred 
• Must be sensitive to patient’s financial and clinical needs while maintaining the patient’s confidentiality 
• Experience in insurance guidelines and programs (i.e., Medicaid and Medicare) 
• Knowledge of ICD-9/10, HCPCS and CPT codes 
• Extensive experience with follow-up on unpaid claims within standard billing cycle timeframes 
• Extensive experience with appealing insurance companies for denied claims 
• ERA payment posting experience 
• Must be able to multi-task and work in a fast-paced environment effectively under deadlines 
• Accuracy and attention to detail is essential 
• Extensive experience in researching issues and providing resolutions 
• Strong analytical and problem-solving skills 
• Must be able to work independently and as a team player 
• In-depth knowledge of Government and non-Government payer sources 
• Experience working with databases and Microsoft Office (i.e., Excel and Word) 
• Ability to work a flexible schedule (i.e., early mornings and evenings) 
• Must have top-notch customer service and follow-up skills 
• Ability to read and interpret medical procedures and terminology 
• Planned Parenthood seeks candidates who are proficient in two or more languages  

Working Conditions

• Standard office environment 
• May experience visual fatigue working at computer with potential extended periods of sitting 
• Well-lit/ventilated 

Physical Requirements

• Ability to lift 10 pounds with or without an accommodation 
• Possess sufficient mobility to perform the Essential Functions listed in this Job Description with or without an accommodation 
• Ability to travel to all agency locations and donor/prospect locations as assigned 

Work Schedule

Benefits & Compensation