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Medical Biller

Prostate Oncology Specialists, Inc. Marina del Rey, CA
  • $55K Annual Salary
  • Full Time
  • Health Insurance
  • Employer Very Likely to Respond

BILLING SPECIALIST

Under minimal supervision.  Responsible for all insurance and patient billing/collections for medical claims and services. Handles all facets of insurance authorizations and coordinates with appropriate staff, patients and insurance companies to completion. Duties include the review accounts, prioritization/triage of accounts, and updates any insurance contracts.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • All insurance authorizations / coordination of authorizations which include pharmacy, outside procedures and most in-house procedures according to company protocols.
  • Coordinates with back office staff regarding in-house authorizations.
  • Documents in EMR processing of authorizations.
  • Verifies all new insurance.
  • Responsible for all billing and charges posting/processing to insurances and patients (in accordance with insurance and protocol requirements). Communicates effectively to payors and/or claims clearinghouse.
  • Provides all necessary documentation (on or with HCFA1500/ERA) required to expedite payments. This includes demographic, authorization/referrals, UPIN number, and referring doctors. Submits claims within 24 hours of print date. Completes all billing forms (HCFA 1500) and processes in timely manner.
  • Keeps updated on insurance and regulatory requirements (includes meaningful use).
  • Processes insurance refunds.
  • Submits and resubmits claims (electronic and paper) to the insurance carriers, includes working with clearinghouses for EFT/ERA resolutions/payments.
  • Submits any supporting documentation required by payors and documents all work done in EMR appropriately.
  • Obtains appropriate medical records with patient and/or responsible party authorization on file as they relate to the billing process.
  • Handles all billing issues, and maintains a password log of insurance companies, etc.
  • Verifies accuracy of charges rendered and correct coding.
  • Communicates to any office staff as needed about billing protocols, updates (i.e. coverage determinations).
  • Enters in all insurance contracted fee schedules (quarterly, yearly).
  • Processes any necessary insurance/patient correspondence. Mails accurate statements to patients within 24 hours of print date.
  • Posts and process payments (insurance and patient) to accounts.
  • Collects /contact patients on behalf of clients for payment of copays, deductibles and/or non-covered services, as required (new patients, inquires, check-in).
  • Assists patients with account inquiries and estimates (discusses discounts with Business manager first).
  • Resolves patient complaints and requests regarding insurance billing and initiates accurate account adjustment. Follows all billing problems to conclusion.
  • Processes patient refunds.
  • Updates Financial Policies, Assignment of Benefits and ABNs as needed.
  • Prepares daily deposit (If requested – business office may do this).
  • Prepares statements/bills within established billing cycle(s) – either monthly or as needed (or combo of both).
  • Runs daily, weekly and monthly reports (or as discussed/needed) and reports discrepancies/concerns to the manager.
  • Reviews aging reports and maintains that accounts do not go 60-90 days without explanation.
  • Collections and aging report review for outstanding balances.
  • Collect overdue accounts / process for collections to business manager, if needed.
  • Contacts patients, guarantors or insurances to recover unpaid or partially paid claims.
  • Reports any trends/delays to supervisor.
  • Verify and report accurate cash collection information per Company procedures.
  • Provide customer service support to clients as required and dictated by Company.
  • Complies with OSHA and HIPAA, other confidentiality regulations.
  • Maintains chart noting and accurate and timely documentation into EMR system.
  • Keeps up to date on prostate cancer treatments, research billing, off-label billing.
  • Updates themselves on new updates or protocols within the EMR.
  • Maintains confidentiality agreements in regards to office, patient account status and the financial affairs of clinic/corporation per company policy.
  • Duties assigned by Business or Office Manager and perform other related duties and assignments as required.

 QUALIFICATIONS / REQUIREMENTS

3 – 5 years in medical billing and collections.  Must have a comprehensive understanding of Medicare and PPO insurances, and policies and procedures.   (We do NOT do HMO/Medi-cal billing.)

Computer knowledge required with a intermediate understanding of Microsoft Word and Excel.  Must communicate well (written, verbal), have strong project management and organizational skills. Should have experience in "customer service" and an ability to work with a variety of clients and client's staff.

PERFORMANCE REQUIREMENTS

  • Current coding ICD10 (or future) knowledge
  • Update and strong knowledge of Medicare rules and regulations
  • Basic knowledge of medical terminology
  • Strong math / bookkeeping skills
  • Problem-solving skills
  • Organization skills
  • Knows how to maintain relationships with patients, physicians, staff, and the public
  • Must be adaptable to changes in regulations, policies, and protocols
  • Must have strong computer skills
  • Must have quality commuication skills in both verbal and written.
  • Independent worker, communicates, listens well. Must be a self-starter

PREFERRED QUALIFICATION

  • 5 years medical billing experience
  • Medical Billing experience in Oncology
  • Knowledge of Medical terminology
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