Job Description
Job Description
Overview :
The Medical Biller will perform tasks and functions associated with all aspects of medical billing. The Medical Biller will follow the established job performance standards for the position and will have a fundamental knowledge of hospital and physician billing procedures.
Essential Duties & Responsibilities :
1. Daily operations to ensure appropriate billing : Has a general knowledge of third party insurance and an extensive knowledge of the insurance carrier assigned to include but not limited to the following : timely filing limits, coordination of benefits, deductibles, PCP, HMO, PPO(Federal and State insurance), capitation, referrals, specialty services, in network co-pays, out of network co-pays, authorizations, dual coverage, referrals and consent forms, coverage dates, covered services, non-covered services, coverage limitations and maximums.
Has working knowledge of 837 billing and 835 payer process Each Medical Biller will be responsible to keep up with changes of their assigned carrier and relay this information to the Billing Manager.
2. Explanation of Benefits (EOB) : General knowledge of EOB’s for all third party carriers. Extensive knowledge of EOB for insurance assigned.
Responsible to know when and where to transfer charges, write off charges, resubmit charges, and what codes to use to do each function.
Process all payments on EOB.
3. Payment Processing : Responsible to process all payments to the correct transaction and insurance. Apply payments and contractual write off to each individual transaction in amounts paid to PCH.
Remove payments that insurers have recouped and adjust or resubmit the charge as appropriate. Payments for the month are to be applied by the end of month closing
Qualifications :
- Two to three years experience as Medical Biller, Third Party Biller, or equivalent experience in a health care setting required
- Working knowledge and prior experience with medical terminology required.
- Working knowledge of automated billing systems.
- Proficiency in word processing (i.e. Microsoft Word or equivalent), internet and E-mail programs.
- Proficiency keyboarding skills required.
- Good verbal and written communication skills; ability to read / write / speak English required.
- Ability to exercise and maintain confidentiality, courtesy and patience in responding to inquiries under stressful conditions is essential.
- Knowledge of HIPPA regulations.
Education :
Post High School completion of a medial billing certification program or equivalent required.
PCHC is EOE / M / F / D / V / SO
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