- 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.
- • 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.
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Medical Biller- - Pompano Beach, United States - All Medical Allied
Description
Job Description
Job DescriptionPosition: Biller Coordinator $20.60 to $21.00
Please send resume and HS diploma to
Job Description:
Qualifications:
