General Summary: The Medical Biller is responsible for the timely submission of technical or professional medical claims to insurance companies including physician offices, hospitals, nursing homes, or other health care facilities.
Supervisory Responsibilities: This position has no supervisory responsibilities.
General Requirements: All duties performed will be done accurately and in a timely manner.

1. Daily retrieval of all medical claims using a practice management system.
2. Daily works electronic insurance rejections to retransmit with corrected information.
3. Daily/Weekly verifies that all electronic acknowledgements were received by the insurance carrier.
4. Daily review of EDI statuses with resolution.
5. Daily review of flags in the POD charge correct process using practice management system.
6. Reviewing and making necessary corrections to workflow statues assigned, to include approving and batching daily work.
7. Notifying the Coding team of any variations in HCM edits and or rejections
8. Adding and verifying pertinent information by carrier specific requirements before claim submission
9. Notifying Accounts Receivable resolution leadership team of identified denial trends.
10. Ensure all claims are submitted with a goal of zero errors.
11. Meet deadlines and maintain productivity standards.

Essential Job Responsibilities:

1. Works all identified coding edits through the electronic billing system.
2. Review patient bills for accuracy and completeness and obtain any missing information.
3. Escalates issues and trends to department leadership.
4. Research required information and pending follow up on a daily/weekly basis for all non-transmitted claims.
5. The ability to apply payer specific policies, Local Coverage Determinations and National Coverage Determination for successful claim submission.
6. Must have excellent written and verbal communication skills.
7. Strong attention to detail and exceptional organizational skills are required.
8. This position will require driving a company vehicle or a personal vehicle; therefore, employees must successfully complete a motor vehicle history check, possess, and maintain a current valid Texas Driver License, and proof of current insurance to be subject for mileage reimbursement.

Education and Training: Minimum high school education or equivalent. Required completion of a program specializing in an area of medical billing and coding or equivalent work experience.
Experience: Minimum of 2 years in a medial office setting. Knowledge of ICD-10 and CPT codes highly preferred.
Other Requirements: Computer Skills : Knowledge of word processing software, spreadsheet software; internet software and database software. Strong understanding of the life cycle of a medical claim and the skills to change the process and submit clean claims.
Work Environment: Depending upon the area assigned, maybe 100% clinical setting or office setting in a clinical environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.
Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 10 lbs. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.
Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.
Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.