BILLER - ORTHOPEDICS (HYBRID)

Overview: The biller demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant and the commitment to Extraordinary Care for Every Generation. Responsible for prompt and accurate billing and follow-up for all hospital and related professional services provided to patients covered by third party payers, including: Medicare, Medicaid, Blue Cross, Commercial, Workers Compensation and all Managed Care Programs. Responsible to secure timely and accurate reimbursement from third party payers and patients based on appropriate billing and follow up activities. Responsibilities:

Demonstrates excellent customer service.

Contributes to organization success targets from patient satisfactions and net operating margin.

Resolves patient billing inquiries and problems, follows up on balances due from insurance companies and patients.

Able to assist patient/family with questions or concerns about their account as it pertains to payment/reimbursement and setting up payment contracts.

Performs insurance billing clerical duties including review and verification of patient account information against payer program specifications.

May enter data electronically to process charges, payments. denials and adjustments.

Understands the Revenue Cycle.

Maintains knowledge of Federal, State and local billing regulations, and informs management and compliance department of discrepancies.

Completes and submits claims for payment, electronic or hard copy, including initial billing, all insurance re-billing, and secondary or subsequent billings.

Responsible for accuracy and third party compliance in all aspects of billing activities in particular in relating to clinical attachments, cpt coding, occurrence, condition and value codes, pre-certification, contractual adjustments or required forms.

Strictly adheres to all rules/regulations and quickly responds to changes, as notified by insurance carriers, employers, third party payers, or government agencies.

Understands the relationship of timely and thorough claims follow-up to assist in the reduction of days in accounts receivable and payer turn around.

Has a thorough understanding of all HMO, PPO, or managed care contractual relationships and able to determine if correct payments and adjustments were made.

Able to identify a credit balance account and make the correct determination as to who/where the credit balance should be refunded or transferred.

Reports all repeated errors or omissions of patient insurance and demographic information to the manager.

Corrects all claims edits or errors promptly and before submission.

Prioritizes issues and workload effectively.

Works effectively as both a team member and one on one

Ability to communicate effectively both verbally and in writing

Qualifications:

EDUCATION/EXPERIENCE

High School Diploma or equivalent.

Associates Degree preferred.

Must have some post HS education, preferably in accounting, information systems or third party billings.

Must have a minimum of 18-24 months of relevant work experience or equivalent combination of training and relevant work experience.

Hospital billing and insurance claim processing experience preferred. Insurance and/or account follow-up techniques experience preferred.

KNOWLEDGE/SKILLS/ABILITIES

Should have strong working knowledge of departmental policies, procedures and business operations and how they interrelate to other departments in the organization

Third party billing and collections

Basic understanding of UB-94, 1500,CPT, ICD-9 Coding.

Knowledge of hospital and/or medical billing and insurance claim filing.

Insurance and/or account follow-up.

Knowledge of medical and insurance terminology.

Minimal typing skills of 35 words/ minute.

Prefer a strong working knowledge of Excel, Word, PowerPoint Must possess clerical skills:10-key, computer, telephone, copier Must have good written and oral communication skills

Must be a team player with the ability to work independently as well as in small or large teams Protects and maintains the confidential nature of information

WORKING CONDITIONS/PHYSICAL DEMANDS

Ability to maintain punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards

Constant hearing

Frequent lifting up to 25 lbs.

Frequent standing, walking, sitting, pushing, pulling, twisting, reaching, handling and hearing

Occasional lifting up to 50 lbs.

Occasional lifting, carrying, climbing, balancing, stooping, kneeling, crouching, squatting and feeling