Position Summary :

We have an exciting opportunity to join our team as a Billing Representative II.

Under general direction, bill, follows-up, correct, and enter claim information in the billing system as assigned by management as a part of the revenue cycle team.

Job Responsibilities :

• Responsible for leading Billing Representatives in the absence of their supervisor.
• Make appropriate corrections to system to satisfy / edit payer requirements and re-submit claims as needed.
• Appeal complex denials through review of payer policies, coding, contracts, and medical records.
• Work closely with provider offices on patient issues.
• Assist department supervisor on special projects and staff training.
• Responsible for assisting the professional billing staff within the CBO with difficult and escalated issues.
• Participate in workgroups and meetings. Attend all required training classes. Escalate issues to management as needed. Maintain confidentiality.

Read and apply policies and procedures to make appropriate decisions. Coordinate functions and work cooperatively with others.

Explain processes and procedures to others. Perform other related duties as assigned.

• Work following operational policies and procedures, and regulatory requirements.
• Ensure that items in assigned work queue(s) are resolved within required timeframes using payer website, billing systems, and CBO pathways.
• Communicate with providers, patients, coders, or other responsible persons to ensure that claims are correctly processed by third party payers.
• Adhere to general practices and FGP guidelines on compliance issues and patient confidentiality.
• Request coding guidance as needed.
• Complete monthly action plans.
• Review reports to identify revenue opportunities and unpaid claims.
• Enter account notes using standard formatting.
• Utilize CBO Pathways as guide for determining actions needed to resolve unpaid or incorrectly paid claims.
• Follow workflows provided in training classes and request additional training as needed.
• Identify payer and provider credentialing issues and address them with management.
• Perform daily tasks in assigned work queues and according to manager assignments.
• Provide input on system edits, processes, policies, and billing procedures to ensure maximization of revenues.
• Perform billing tasks assigned by management which may include data entry, claim review, charge review, accounts receivable follow-up, or other related responsibilities.

Minimum Qualifications :

To qualify you must have a High School Diploma or GED.

Experience in medical billing, accounts receivable, insurance, or related duties; Knowledge of CPT and ICD10; medical billing software;

English usage, grammar and spelling; basic math; 2 years experience in a similar role.

Preferred Qualifications :

Previous experience with medical billing and / or collections. Excellent interpersonal skills, confident demeanor an attention to detail.

Required Skills

Required Experience

Last updated : 2024-05-01