Insurance Biller at Orchard Hospital – Gridley, California

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.