Position Highlights:

• The BMT Biller is responsible for the complex Bone Marrow Transplant (BMT) billing process, including billing CAR-T, BMT Global and BMT Non-Global claims. CAR-T claims are sent either electronically or hardcopy, based on the Managed Care contract or Letter of Agreement (LOA). BMT Global Billing includes both technical (hospital UB04) and professional (physician HCFA 1500) together in a packet that is submitted hardcopy via email, fax, upload or mail. The BMT Biller creates, prepares and maintains Excel spreadsheets of claims billed, notes if services are Global or Non-Global, determines and submits payment amounts for the physician groups and performs a reconciliation of claims billed, paid and denied once the transplant period has ended.
• The BMT Biller must be able to interpret Managed Care BMT contracts, demonstrate knowledge of Pre-Global, Global and Post-Global periods and understand when a medical claim is to be billed electronically on its own or in a packet with other claims.

The Ideal Candidate Will Have:

• Current Medical Billing and Coding certificate.
• Experience with global billing or transplant reimbursement methodology.
• Current HFMA Certified Revenue Cycle Representative (CRCR) certification.

Responsibilities:

• Request demand UB04’s, itemized bills and creates folders for Inpatient and Outpatient.
• Gather data from multiple sources for submission to payer.
• Print and analyze professional HCFA 1500 forms.
• Audit documentation prior to submission to payer
• Create audit/tracking spreadsheet for submission to payer and for Collections to utilize for collection efforts.
• Collect and attach any required notes, forms or other documentation to the paper claims.
• Select the appropriate method of claims submission for each payer submit successfully.
• Confirm patients that have received a Bone Marrow Transplant.
• Create and maintain BMT spreadsheets and ensure they are accurate and up-to-date.
• Verify claim is in the correct Global billing period: Pre-Global, Global and Post-Global.
• Document charges based on printed claims onto BMT Transplant tracking sheet.
• Update spreadsheets based on new claims or payment activity.
• Review accounts for Global payment and update tracking spreadsheet.
• Reconcile charges to the appropriate logs.
• Document all actions taken.
• Identify what CAR-T claims can be submitted electronically vs. what need to be billed hardcopy with attachments.
• Review Letter of Agreement (LOA) for those that need to be billed hardcopy, gather required documents, create, complete and attach any required spreadsheets outlining the Expected Reimbursement Amount and bill hardcopy, noting Soarian with the documents that have been included with the claim.
• Identify any CAR-T claims requiring a corrected claim due to late charges, credits, change in diagnoses, etc. and bill accordingly.
• Submit CAR-T packet after each electronically billed claim, where applicable, to address on the Letter of Agreement.

Credentials and Qualifications:

• High School Diploma/GED required.
• Five (5) years recent medical billing experience in a hospital or large group practice
  setting with the primary responsibility being insurance billing.

OR

• Associate Degree in Healthcare Admin, Accounting, Business, Finance or other relevant discipline
• Three (3) years recent medical billing experience in a hospital or large group practice
  setting with the primary responsibility being insurance billing.