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The Medical Insurance Billing Representative is responsible for the timely submission of institutional and/or professional medical claims to insurance companies.
Utilizes various hospital/physician systems to verify patient, billing and claim information for accuracy.
Performs compliant primary/secondary, tertiary and re-bill billing functions, including electronic, paper and portal submission to government and/or commercial payers.
Edits claims to meet and satisfy billing compliance guidelines for electronic and hardcopy submission.
Responds timely to emails and telephone messages, as appropriate.
Communicates issues to management, including payer, system or escalated account issues.
Participates and attends meetings and training seminars, as requested.
Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements, and JCAHO standards.
Enhances billing department and hospital reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
Updates patient demographics/insurance information in appropriate systems.
Monitors claims for missing information, authorization and control numbers (ICN//DCN).
Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems.
Secures needed medical documentation required or requested by third party insurance carriers.
Maintains and respects the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure.
High school diploma or GED.
At least one year of experience in healthcare insurance billing, working with or for a hospital/hospital system or Physician group, working directly with government or commercial payers.
Experience identifying billing errors, resolving claim edits, resubmitting claims and ensuring maximum reimbursement after adjudication by government or commercial payers.
Experience reviewing EOB, UB-04 and/or CMS 1500 forms to conduct billing activities.
Knowledge of ICD-10, CPT, HCPCS, revenue codes and NCCI.
At least one year of experience with billing software.
Knowledge of billing and accounts receivable practices, medical business office procedures, coordination of benefit rules and denial overturns and third-party payer billing and reimbursement procedures and practices.
Ability to review and understand payer contracts to perform billing activities.
Experience navigating payer sites for insurance eligibility.
Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Microsoft Excel and use company email and calendar tools.
Demonstrated success working both individually and in a team environment.
Ability to work effectively with cross-functional teams to achieve goals.
Demonstrated ability to meet performance objectives.
Experience with Epic, Meditech, Cerner, Invision, Paragon, Soarian or STAR.
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