Job Title: MANAGED CARE BILLER

Job Summary: Responsible for billing all Non-Government claims accurately and timely. Must have knowledge in Government and State billing laws. Knowledge in CPT,ICD-9 and HCPCS codes is a requirement. Submit re-bills for corrected claims, and work billing denial reports within 24 hours from our clearing house systems. Required to document accounts financial systems accurately and timely.

Reports To: Managed Care Manager and or CBO Director

Essential Job Duties:

• Demonstrates competency and knowledge in managed care insurance billing, collections and contracts.

• Reviews and updates accounts with correct payor codes, insurance addresses and financial classes.

• Responsible to request medical records for billing purposes in a timely manner.

• Knowledge in billing and or re-billing of claims through E-premis.

• Demonstrates competency and knowledge in billing secondary plans.

• Knowledge in billing cost pass thru invoices and late charges.

• Demonstrates ability to identify and correct any missing information on claims.

• Demonstrates ability to identify missing charges and request a detailed audit on claims.

• Ability to document in Paragon system with account activity.

• Ability to combine charges when needed on system.

• Demonstrates ability and knowledge in resolving outstanding balances owed on managed care claims.

• Demonstrates knowledge and understanding of managed care contracts.

• Ensures contractual discounts are applied to accounts as specified in each contract.

• Able to apply contract language to each claim as needed for reimbursement calculations/Review Explanation of Benefits.

• Knowledge and experience working with Microsoft Word and Excel programs to create spreadsheets when necessary.

• Ensures contractual adjustments are submitted timely by month end, including capitated accounts.

• Work correspondence and emails timely (within 48 hours)

• Retrieve necessary documents in the HBF system for billing

• Demonstrates full knowledge on interpreting an Explanation of Benefits and identify patient financial responsibility.

• Knowledge and experience in processing refund requests.

• Notifies supervisor of any issues or problems.

• Consistently meets billing goals per department guidelines.

• All other duties and projects as assigned.

Behavioral Standards:

• Exhibits customer and service oriented behaviors in every day work interactions.

• Demonstrates a courteous and respectful attitude to internal workforce and external customers.

• Communicates accurately and appropriately.

• Works well and efficiently under minimal supervision.

• Handles difficult situations in a discreet and professional manner.

• Is adaptable to changes in assignments and priorities.

Communication/Knowledge:

• Provides accurate and timely written and verbal communication of information in a manner that is understood by all.

• Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.

• Able to use IT systems in an accurate and proficient manner.

Collaboration/Teamwork:

• Contributes toward effective, positive working relationships with internal and external colleagues.

• Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization.

Education/Experience:

• High school graduate or equivalent required

• Prefer at least 2 to 3 years of current experience in an acute care hospital setting

• Must be able to multi-task and work in a fast past environment

ADA/Physical Demands:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.

• Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell. The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.