Clerical - Patient Financial

Position: Biller Coordinator

Job Description:

Responsible for the timely submission of claims to Medicare, Medicaid and private third party insured and prescription drug payers; Corrects and resubmits front-end and back-end rejected claims.

Ensures the accuracy, completion, timely submission, and maintenance of all documentation necessary for coverage, compliance, and reimbursement by routinely performing claims auditing and review processes.

Verifies that the services and products are correctly authorized, and that required documentation is on file.

Responsible for the timely follow-up and collection of payments due to the organization. This is accomplished by generating invoices and/or following up with patients and/or payers.

Uses extensive knowledge of pharmacy benefits, infusion coverage criteria, medical insurance billing and coding to bring resolution to account balances.

Responsible for reviewing remittance data and reconciling payment amounts; Responsible for the review and reconciliation of all claims processed and assists the reimbursement department by resolving billing issues.

Keeps the Director informed of system issues which impede the ability to transmit claims and works with teammates, both within and outside the department, to resolve such issues.

Holds themselves accountable for meeting individual productivity goals set by the Director as well as team goals set by the department; Completes work in a timely manner.

Communicates effectively with teammates within department; Supports the team culture within the organization by adhering to policies, practices, and the Company's mission statement.

Performs job responsibilities within established regulatory guidelines (HIPAA /PHI) and reports non-compliant activity to the Director.

Protects patient and company confidentiality in all matters of processing accounts.

Provides exceptional customer service to patients, internal and external customers, all contacts, and third-party payors; interacts in a professional manner with all teammates in order to promote a cohesive working environment.

Looks for ways to improve and promote quality processes within and outside of the department.

Adapts to and demonstrates multi-tasking skills when dealing with frequent changes in an ever evolving work environment.

Recognizes the need for change and the results of improved work processes.

In cases where electronic transmission is not available, the Reimbursement Specialist assures that a paper claim is properly completed and submitted in a timely manner.

Evaluates payments are received in accordance with the fee schedule.

Works with the intake and reimbursement department to manage the entire reimbursement process from insurance verification through final collection.

Manages the refund process for any overpayment and/or duplicate payments for the same service.

Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided.

Trains, educates, and supports staff on Medicare guidelines and updates, regulatory and compliance requirements, and accurate claims submission processes.

Other duties as assigned by management. Qualifications:

• Graduation from an accredited high school or attainment of a GED certificate from an accredited institution.

• Experience with CPR+ system.

• Knowledge of Medicare and other regulatory billing codes and practices to assess billing for accuracy prior to submission to appropriate agency or company for processing and payment. Should be well-versed in regulatory guidelines and industry standards for Medicare and/or specific payer benefit providers.

Knowledge of Medicare and third-party codes and billing procedures as well as patient billing techniques.

Healthcare billing and collections experience.

Possess excellent medical and billing terminology skills; Ability to read, analyze and interpret prescription drug orders.

Familiar with accepted billing/collection/reconciliation practices in a health care reimbursement setting.

Detail-oriented with strong organizational skills.

Ability to multi-task, prioritize, meet deadlines, and work independently.

Knowledgeable and understanding in products and services provided by Patient Care America and program documentation requirements.

Ability to anticipate the needs of the facilities and patients that we service.

Possesses good interpersonal skills; ability to work independently and as part of a team.

Facilitates work production results by incorporating exceptional planning and organizational skills.

Utilizes clear verbal communication skills to source and exchange information; utilizes written communication skills to prepare documentation and report results as warranted by job responsibilities.

Applies analytical skills to pre-established work processes that may require preparation of reports or documents for further review or analysis.

Ability to identify problems within the work routine that can be handled at level and refer escalated matters for further resolution.

Computer literacy in standard office applications.

Promotes a philosophy that is customer driven with excellent service results.

Please reference Job number: 235712