Medical Biller - Staffing Technologies : Job Details

Job Summary

Reporting to the Chief Financial Officer (CFO), the Senior Biller and Coder processes the claims and coding for services provided. Abiding by county, state and federal regulations, the Senior Biller and Coder prepares and submit claims to insurance companies and government agencies to receive payment for medical services rendered and assigns standardized codes to diagnoses and procedures to facilitate communication and reimbursement.

The Senior Biller and Coder is familiar with industry standards and insurance companies, billing and coding regulations, and follows standards in accordance with Centers for Medicare & Medicaid Services (CMS), California Children's Services (CCS), Genetically Handicapped Persons Program (GHPP) and all other State and Federally sponsored programs.

Essential Job Duties

• Code and process all billable visits using accurate E&M, CPT, ICD-10 and other billing codes and standards following timely filing guidelines, policies and procedures.
• Work directly with the Triarq billing service to submit claims. Follow-up on and refile as needed claims that have no response or were denied, delayed, or postpaid. Research underpaid claims to ensure claims are processed in accordance with existing Health plan contract. Submit appeals to insurance companies as needed. Minimize number of unpaid accounts for all insurance payers and self-pay balances. Track all claim submissions through the Practice Management (PM) aspect of the Electronic Medical Record (EMR) system.
• Maintain and update accurate databases with Insurance companies. Review high level complaints and respond back within department standards. .
• Maintain credentialing (and re-credentialing) applications to payer networks to begin billing for services and obtaining reimbursement. Works with providers and administrative team members to collect required documentation, verification of credentials, and confirmation of clinical expertise.
• Stay up to date on industry standards set by the Centers for Medicare & Medicaid (CMS), commercial insurance plans, Medi-Cal and county managed care plans by attending seminars, conferences and other programming related to claims and billing.
• Prepare regular reports (weekly, monthly) and participate in regular meetings on the status of claims and the financial impact of timely filing, lack of documentation and other things that can impact payment.

Requirements

• Graduate from high school or equivalent.
• Graduate from an accredited school or program in Medical Billing and Coding.
• 5 years of experience in medical billing, ideally in an outpatient setting.
• 2 years of experience in infusion billing and coding.
• Experience working with all payers – commercial, government, Medicare, Medicaid.

Preferred Qualifications

• Associates degree from an accredited college.
• Certified Professional Biller (CPB), Certified Billing and Coding Specialist (CB Certified Medical Billing Specialist Certificate (CMBS) or similar certification.
• 1 year experience with EMR/PM software.

Licensure/Certification/Registration:

• Basic Life Safety (BLS) training
• HIPAA training

Other Required Skills and Qualities

• Working knowledge of CMS regulations and requirements regarding billing and coding.
• Working knowledge of CCS/GHPP/Medi-Cal/HIPAA regulations and requirements, and understanding of third party payer methods and regulations.
• Working knowledge of HCPC/E&M/CPT & ICD-10 codes related to Hematology and related services.
• Working knowledge and understanding of the relationship between procedure and diagnosis compatibility to maximum reimbursement.
• Advanced knowledge of billing denials and appeals processes