Medical Biller

Springfield, MA

General DescriptionProvide front-line medical billing support to billing department and other staff as appropriate.  Work Denials and Appeals in a timely and efficient manger ensuring the compliance of meeting timely filing deadlines.

Reports To: Medical Billing/Coding Supervisor & Departmental Director

Supervises: N/A

Salary/Status: Non-Exempt

Minimum Requirements:

  1. Medical Billing, two to five years of experience required.
  2. High school diploma or equivalent required.
  3. Experience with compliance, working medical billing denial & appeals, as well as experience in registering patients and entering/reconciling charges in a medical billing system as needed.
  4. Ability to establish and maintain effective working relationships with third party payers, individuals seeking assistance, and the general public.
  5. Professionalism in behavior and appearance
  6. Ability to prepare financial and statistical billing reports as needed.
  7. Computer literacy and PC application skills
  8. Ability to type at least 35 WPM
  9. Ability to work within a team as well as work independently as need.
  10. Problem- solving skills to research and resolve discrepancies, denials and appeals.
  11. Current knowledge and understanding of medical terminology.
  12. Effective communication abilities for telephone contacts with insurance payers to resolve issues.
  13. Customer Service skills to include a calm demeanor for interacting with patients regarding medical claims and payments; including communicating with patients and family members of diverse ages and back grounds.

Principal Responsibilities and Duties:

  1. Responsible for reviewing, processing & submitting medical claims using Epic billing software for numerous medical payers including the submission of electronic and paper claims processing/submission.  
  2. Review medical & patient bills for accuracy and completeness, obtaining any missing information before submission.
  3. Familiar with CPT codes, ICD-10 codes, HCPCS II codes based on documentation, payer requirements and billing policies.
  4. Compile, complete, verify, correct and/or register insurance information for new and existing patients.
  5. Process sliding scale discount applications, set up payment plans and process self-pay medical payments over the phone for patient business matters.
  6. Follow up on unpaid claims within standard billing cycle time frames.
  7. Work with Supervisory staff to resolve reimbursement issues by calling insurance companies regarding any discrepancy in payments if necessary.
  8. Identify and bill secondary or tertiary insurances and see opportunities to reduce denials and enhance revenue.
  9. Research and appeal denied claims for all payers.
  10. Answer all patient, insurance or attorney telephone inquiries pertaining to the assigned accounts.
  11. Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid and other payer requirements.
  12. Maintains library of information/tools related to documentation & billing guidelines.
  13. Maintains confidentiality of account information.
  14. Concurrently bills, resolves and records noted billing issues and provides ongoing feedback to Billing Department Supervisor & Director.
  15. Stays up to date with billing compliance with FQHC guidelines for billing of medical services.  Education includes the Evaluation and Management coding requirements. 
  16. Identifies problems related to assigned duties and proposes solutions.
  17. Work with Medical Billing Supervisor, Departmental Director, EHR training staff and/or Super user(s) of EHR/EPM system, to become proficient in all aspects of learning and using the Epic/Ochin practice management system correctly for your assigned job duties.
  18. Performs other duties as assigned by the Medical Billing/Coding Supervisor or Departmental Director.

This position requires the ability to use a computer workstation, operate a key board and sit for 8 hours a day within an onsite office setting.

From time to time, this position requires the ability to work long and arduous hours.

JOB CODE: 1000125