Medical Biller / Billing Clerk

Job Description:

Responsible for maintaining the professional reimbursement program. Ensure compliance with current payments and rules that impact billing and collection. Follow-up of any outstanding A/R all-payers, self-pay, and or the resolution of denials and manage correspondence.

Requirements

General Accountabilities

• Performs billing and computer functions, including patient & third-party billing, data entry and posting encounters.
• Prepares and submits clean claims to various insurance companies either electronically or by paper.
• Handle the follow-up of outstanding A/R all -payers, including self-pay and/or the resolution of denials.
• Answers questions from patients, SGMC staff and insurance companies regarding any issue pertaining to the billing department.
• Identifies and resolves patient billing complaints.
• Prepares, reviews for accuracy, and send patient statements.
• Handle all correspondence related to insurance or patient account, contacting insurance carriers, patients and other facilities as needed to get the maximum payments on accounts and identify issues or changes to achieve client profitability.
• Process and post all patient and/or insurance payments.
• Performs other necessary duties as required by SGMC achieve the goal of providing primary health care.
• Other duties as assigned by Supervisor or Administrative team.

Job Qualifications

• Must understand and have in Medicaid, Medicare, Commercial Insurance and Self Pay Billing.
• Understand or become familiar with FQHC billing practices.
• Understand Sliding Fee determination guidelines.
• Able to analyze the billing data.
• Ability to read and interpret insurance contracts and fee schedules
• Proficient in Microsoft Office.
• Intermediate skills in Excel.
• Ability to communicate verbally and in writing clearly and effectively with all staff including execute staff.
• Prior work experience as a coder and biller is helpful.
• Knowledge of third-party billing requirements, ICD-10 and CPT codes
• Needs good interpersonal skills and ability to work as a member of the team to serve the patients.
• Accurate & detail oriented
• Ability to work independently

Education/Experience

• High School diploma or GED
• High level of Integrity, know HIPAA regulations and rules.
• Ability to work independently and meet all reporting deadlines.

Skills

• Excellent verbal and written communication
• Problem solving
• Coordinate
• Delegate
• Prioritize
• Adaptability
• Ability to use computer and multi-lined telephones
• Understanding of billing practices
• Oral and written proficiency in English

Physical Demands and Working Conditions

The physical demands described here are representative of those that must be met by a service member to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.