Responsible for ensuring claims are billed in an accurate and timely manner in accordance with federal and state billing requirements.• Responsible for billing the appropriate third party commercial or government insurance carrier through the effective handling of all billing edits in work queues or daily assignments. • Maintain a strong working knowledge of commercial and governmental insurance billing guidelines and regulations. Seek and maintain knowledge by researching applicable electronic bulletins, reference manuals, or by consulting with insurance representatives. • Maintain a strong working knowledge of payer information as it relates to bundling and unbundling charges, medical necessity and general coding specifications to handle late charges and combine billing. • Maintain a strong working knowledge of how billing processes specific to payer requirements as it relates to 72 hour rules, inpatient readmissions and balance billing patients. • Work with the clinical staff to resolve claim issues. • Monitor and process all research and client (contract) billing to make sure all charges are correct and are being billed to either research/contract and/or patients. • Perform other duties as assigned.
Education • Minimum: High school diploma or equivalent. Experience • Minimum: One year experience in a health care setting (hospital or physician) or experience working for a health insurance company or related organization. • Preferred: Clerical skills with a working knowledge of accounting and insurance coverages and three years of experience in a physician or hospital billing office. Skills/Training • Minimum: PC and keyboarding skills. Working knowledge of 10 key, typing and computers. • Preferred: Knowledge of health insurance billing guidelines. Ability to type/key accurately. Effective verbal, written, and customer service skills. Primary Responsibilities • Meet and exceed all performance standards established by Management.