Medical Biller II at PIONEERS MEMORIAL HEALTHCARE DISTRICT – Brawley, California

SUMMARY:

This position is responsible for supporting the Professional Medical Billing team by posting payments, capturing/working denials, and working outstanding accounts receivable (A/R) balances and other assigned duties as needed. They will be responsible for assisting in analysis and resolutions of clinic reimbursement issues, clinical statistics, recommending CDM updates for clinic services and assisting Management with other billing responsibilities as assigned.

ESSENTIAL FUNCTIONS:

• Perform posting charges and completion of claims to payers on time
• Review transmitted claim via clearing house, working rejected claims as needed
• Review patient bills for accuracy and completeness, and obtain any missing information
• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing
• Follow up on unpaid claims within a standard billing cycle timeframe
• Check each insurance payment for accuracy and compliance with contract discount
• Call insurance companies regarding any discrepancy in payments, if necessary
• Identify and bill secondary or tertiary insurances
• Review accounts for insurance or patient follow-up
• Research and appeal denied claims
• Answer all patient or insurance telephone inquiries on assigned accounts
• Update billing software with rate changes
• Reading and interpreting insurance explanation of benefits (EOBs)
• Understanding and knowledge of ICD-10, CPT Codes, and HCPCS Level II Codes
• Posting ERAs, paper checks, credit cards, and balancing lock box
• Provides guidance to clinical staff in regards to insurance updates, edit updates, and payer updates
• Assist Medical Biller 3 with assigned duties
• Minimal supervision may be required by billing manager

OTHER RESPONSIBILITIES:

• All other duties as required and assigned.
• Maintains follow-up until records are completed and billed
• Ability to multitask and meet deadlines
• Maintain patient confidentiality as per the Health Insurance Portability and Accountability Act
• Utilized EMR, including patient accounting and registration systems to their full capacity.
• Flexible with varying hours based on the needs of the department.
• Good written and verbal communication skills required for contacts.

Within other departments, patients, families, the community, and medical staff

SUPERVISORY RESPONSIBILITIES:

None

EDUCATION, KNOWLEDGE, SKILLS, ABILITIES, AND EXPERIENCE:

• Education: high school graduate or equivalent required.
• At least one to years of experience working with Medicare, Medi-Cal, and Insurance.
• Knowledge of ICD-10 & CPT-4 coding functions.
• Knowledge of Medical Terminology.
• Mathematical ability required to review statistical data on various financial records.
• Experience in data entry (IBM compatible computer).
• Expertise in the electronic and paper systems used in billing health care systems
• Close attention to detail and excellent problem-solving skills
• Ability to use standard office equipment such as calculator, copier, FAX, etc.

LICENSES AND CERTIFICATIONS:

AHA Basic Life Support

AGE OF POPULATION SERVED:

Newborn  Infant/Pediatric  Adolescent  Adult Geriatric  All X No Patient Care

PHYSICAL REQUIREMENTS:

• Occasional travel between training locations required.
• Travel within the communities required
• Sitting for extended periods of time
• Stooping and bending are required.
• Dexterity of hands and fingers to operate a computer keyboard, mouse, power tools, and to handle other computer components.
• Some lifting of more than 50 lbs. may be required.
• Computer entry