Job Description

Job Description

Job Description

Description:

Position Summary

Responsible for maintaining all the billing queues assigned in which insurance is verified, billed and reviewed for the purpose of obtaining payment from the intended carrier. The biller is responsible for making sure all procedures are followed as outlined in the maintained work instruction documents for the program outlined.

Supervisor

Billing Manager

Department

CBS

Essential Duties of the Position

• Pull information needed to bill or assess status of insurance claim from client systems.
• Correctly read EOB’s to determine if insurances have paid in the proper order, and the correct amount of patient responsibility. Does additional billing need to take place?
• Ensure claim is entered in eHealth under correct provider name and address and provider identifying numbers.
• Hand key required field locators on UB-04 or CMS-1500 form in eHealth.
• Ensure accuracy of claim in eHealth or client billing system; run through appropriate HIPAA edits and correct claim errors as required.
• Bill claims using the clients billing system for certain clients and updating insurance properly in those system (see: P:\CBS\CBS FOLDER\Client System Work Instructions)
• Update FACS with note regarding billing of claim and move to appropriate follow-up status.
• Send paper claims with appropriate attachments to scanning.
• 2101 letters provided by work comp attorney
• Split among staff for billing to POEs.
• Bill and/or follow-up on Medicare accounts
• Check eligibility and correct claims in Med A.
• Advise the client of Medicare billing issues for specific accounts, i.e. the need for modifiers, lines that have denied for medical necessity.
• Use Med A or the Medicare IVR to determine the status of the claim.
• Determine patient responsibility after Medicare payment and move accounts to correct queues.
• In liability situations, determine what entity is responsible for payment of the claim.
• Bill and/or follow-up on Medicaid accounts
• As allowed by individual client access, submit claims via Indiana Medicaid web interchange.
• Check eligibility and claim status via Medicaid websites.
• Advise the client of Medicaid billing issues for specific accounts, i.e., the need for modifiers, lines that have denied for medical necessity.
• Determine patient responsibility after insurance payment and move accounts to correct queues.
• In liability situations, determine what entity is responsible for payment of the claim.
• eHealth Payer Reports
• review payer reports in eHealth for up front claim rejections
• Transmit electronic claims before 2:00 pm each day.
• Print and sort paper claims at the end of each day.

Responsibilities of the Position

• File limit accounts worked as assigned by manager
• Over 15 K accounts worked as assigned by manager
• WCP state file limit accounts worked as assigned by manager
• Urgent billing emails as assigned by manager
• Check eligibility
• Make calls to insurance companies to check eligibility and verify the claim submission file limit
• Check eligibility on Passport and insurance websites.
• Accurately determine if the claim should be filed according to the eligibility status of the patient.
• Keep supervisor updated on significant issues that may be discovered in regards to certain payers or suggestions of how we can improve processes.
• Meet deadlines for account review, completion of spreadsheets at the request of management.

Requirements of the Position

• Computer proficiency skills are required
• Ability to learn quickly and navigate effectively through multiple systems
• Excellent verbal and written communication skills
• Ability to work in fast-paced, changing environment
• Must be flexible and adaptive to change in order to support operations
• Demonstrates attention to detail and organization
• Must have the ability to perform repeated tasks with a high level of accuracy
• Must have working knowledge of HIPAA, FDCPA, and Red Flag regulations

Difficulty of Work

Work activities are performed independently, utilizing basic guidelines as standards of performance. The incumbent must deal with a variety of reports, documents, and computer systems, and must utilize good judgment in carrying out job duties. Advice and guidance may be sought from the department’s Manager as warranted to ensure the provision of quality service.

Responsibility

The incumbent works in a team concept, but will need to be able to work accounts on his/her own. Accounts are randomly checked for training purposes. Errors may be caught, but not immediately. Work is somewhat independent in nature. The incumbent makes a substantial impact on the processing of the account based on actions completed.

Personal Work Relationships

Incumbent works with colleagues, team leads, supervisors and management staff.

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