Insurance Biller

Position Summary

Performs all aspects of third party payor medical billing and ensures accurate and timely billing of receivables. Audits and bills claims according to federal, state, and payor regulatory and compliance requirements.

Essential Duties

Executes patient accounting system downloads and claim editing software daily procedures on a rotation basis with other insurance billers.

Reconciles data from patient accounting systems to claim editing reports and resolves any discrepancies. Identifies and reports any system network problems to Application Analyst or Supervisor.

• Has a thorough understanding of CPT, HCPCS & ICD-10 codes, HCFA and UB04 claim forms and can understand payor EOBs and ERAs.
• Performs team's third party payor billing (primary, secondary, tertiary) using claims editing software. Reviews claims for accuracy and completeness and obtains any missing information.
• Facilitates submission at time of billing for medical records or other documentation when required by payor for appropriate claims processing.
• Evaluates and researches claims billing denials and reject reports in a timely manner. This includes pulling patient insurance information, verifying patient eligibility, researching payor websites, and / or calling payors for assistance regarding the denial or reject reasons.
• Researches incomplete charges, registration, or diagnosis information with responsible department and ensures resolution before submitting claim to payor.
• Maintains a current and thorough working knowledge of federal, state and payor billing regulatory and compliance requirements.

This includes HIPAA & EDI requirements, with emphasis on billing transaction standards 837i and 837p. This includes signing up for payor newsletters and list serves.

Reviews managed care contract matrix for contract and billing changes. Comprehends and demonstrates ability to comply with governmental billing requirements such as Medicare OPPS and CCI / OCE claim editing.

Attends external and internal education programs when necessary.

Communicates regularly with the Patient Financial Services (PFS) Supervisor or Manager regarding high-risk accounts. Identifies and refers accounts and billing problems to the Billing Supervisor when routine guidelines to correct problems are not producing results.

Other Duties

• Assists the PFS Supervisor when reviewing various reports in the patient accounting system and billing to identify problems within accounts that prevents the claims release in order to avoid time filing problems.
• Identifies and reports to supervisor incorrect insurance data entry trends in patient accounting system and identifies incorrect insurance information in the patient accounting system and claims editing software Insurance Directories.
• Provides PFS Supervisor with weekly productivity statistics and reports workload fluctuations (backlog or shortages) in a timely manner.

Maintains individual goals established by PFS management.

Performs as a back-up to staff absences and vacancies, as necessary.

Competencies

• Accountability : Accepts full responsibility for self and contribution as a team member; displays honesty and truthfulness;
• confronts problems quickly; displays a strong commitment to organizational success and inspires others to commit to goals;

demonstrates a commitment to Patient Financial Services Departments and National Jewish Health.

• Adaptability : Maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusting effectively to work within new work structures, processes, requirements, or cultures.
• Attention to Detail : Accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job;
• accurately checking processes and tasks; being watchful over a period of time. Setting high standards of performance for self and others;

assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence rather than having standards imposed.

Collaboration / Teamwork : Cooperates with others to accomplish common goals; works with employees within and across his / her department to achieve shared goals;

treats others with dignity and respect and maintains a friendly demeanor; values the contributions of others.

Decision Making : Identifying and understanding issues, problems, and opportunities; comparing data from different sources to draw conclusions;

using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints, and probable consequences.

• Initiative : Taking prompt action to accomplish objectives; taking action to achieve goals beyond what is required; being proactive.
• Managing Work and Time : Effectively managing one's time and resources to ensure that work is completed efficiently. Effectively manages project(s) by appropriately focusing attention on the critical few priorities;

effectively creates and executes against project timelines based on priorities, resource availability, and other project requirements (i.

e., budget); effectively evaluates planned approaches, determines feasibility, and makes adjustments when needed.

Perseverance / Resourcefulness : Accesses and utilizes available resources inside and outside the company.

Supervisory or Managerial Responsibility

None

Travel

None

Core Values

• Be available to work as scheduled and report to work on time.
• Be willing to accept supervision and work well with others.
• Be well groomed, appropriately for your role and wear ID Badge visibly.
• Be in compliance with all departmental and institutional policies, the Employee Handbook, Code of Conduct and completes NetLearning by due date annually.
• Fosters an inclusive workplace where diversity and individual differences are valued and leveraged to achieve the vision and mission of the institution.
• Adheres to safe working practices and at all times follows all institutional and departmental safety policies and procedures.
• Wears appropriate PPE as outlined by the infection control policies and procedures.
• Demonstrates compliance with all state, federal and all other regulatory agency requirements.

Minimum Qualifications

• Education : High school graduate or equivalent required. Some college level course work, preferred.
• Work Experience : A minimum of two (2) years of recent and related healthcare collection or billing experience is required.

A minimum of one (1) years insurance billing, accounting and customer service environment is preferred.

Special Training, Certification or Licensure : None

Salary Range : $18.29 - $21.00

Benefits

At National Jewish Health, we recognize that our outstanding faculty and staff are the essence of our organization. For every aspect of health care, our employees are our greatest asset.

With that in mind, we have designed a valuable, comprehensive benefits package to meet the needs of our employees and their families.

• Medical Plans, Dental Plans and Vision Insurance
• Retirement Plan
• FSA and HSA
• Short and Long Term Disability
• Life Insurance and AD&D
• Voluntary Benefits, like Accident Insurance, Critical Care and Hospital Indemnity
• Sick and Vacation Paid Time Off
• Wellness Program
• Legal Plan
1 day ago