Identification Section

Position Title: Medical Biller

Department: Corporate EEOC Class: SW

Reports To: Billing Manager FLSA Status: Non-exempt

General Summary

Responsible for preparing, reviewing and submitting claims to various payers either electronically or paper. Responsible for following up on unpaid claims, denials and rejections utilizing daily and monthly reports.

Essential Job Functions

• Review and transmit claims using billing software, including electronic and paper claim processing, determine problem that resulted in a rejected claim, resolve, advise on procedural changes to implement and prevent further such rejects, daily
• Effectively communicates via phone with customers, employees and vendors using exemplary customer service skills
• Runs A/R report monthly to work on denials (works accounts receivable 90-120)
• Assists patients with questions regarding insurance and/or account balances and assists front office with set up of patient payment plans
• Properly completes timesheet, daily
• Regular, consistent, and predictable attendance per PRO-PT’s attendance and punctuality policy;
• Responsible for attention to detail, organization, cleanliness, strong multitasking and time management skills
• All other duties as assigned IE: Training staff, ordering office supplies etc. 

Knowledge, Skills, and Abilities

• Knowledge of insurance guidelines and payer requirements 
• Knowledge and understanding of HIPPA
• Knowledge of CPT and ICD-10 coding and medical terminology
• Knowledge of medical professional fee billing
• Knowledge of Managed Care, Work Comp, HMO, Medi-Cal, Medicare…etc. (contracts)
• Skill to perform computer & data entry functions
• Able to operate office equipment, including but not limited to keyboard, copier, telephone, fax machine and calculator
• Knowledge of proper lifting techniques
• Detailed oriented and highly organized
• Ability to type forty-five (45) wpm
• Ability to self-motivate and work effectively in an independent environment
• Ability to read and understand different EOB’s (explanation of benefits)
• Ability to multi-task, recognize, evaluate, solve problems and correct errors
• Ability to work well in a team environment. 
• Ability to successfully complete training.
• Ability to communicate in writing, over the phone, and in person with office staff, patients and insurance representatives
• Ability to explain instructions and guidelines to others effectively.
• Ability to determine work priorities. 

Education and Experience

• High School Diploma or Equivalency.
• Minimum of 1 year experience in healthcare billing
• 40-45 WPM
• Data processing and medical terminology preferred. 

Physical Requirements

Working Conditions: Normal working conditions absent extreme factors.