Job Title : Billing Representative

Duration : 6-months with possibility of extension

Schedule : Monday Friday / / 8am-4 : 30pm

Location : Hybrid - Tampa, FL

It may also include quality assurance and audit of billing activities.

ESSENTIAL FUNCTIONS :

• Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with every internal and external customer.
• Represents the Company in a professional manner, following all Company policies and procedures.
• Uses, protects, and discloses patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Ability to establish and maintain effective and positive working relationships with staff and management.
• Ensures the timely submission of primary and secondary claims.
• Maintains current working knowledge of CPT and ICD 10 codes, required modifiers and encounter data.
• Performs electronic claims submission.
• Notifies management of issues arising from erroneous codes, missing information, and error / edit messages.
• Analyze relevant information to determine potential reasons for billing discrepancies and changes.
• Seek assistance from internal partners (e.g., Coding; Credentialing; Clinics; Contracting) and / or external stakeholders (e.

g., individual customers / payers; brokers) to resolve billing issues.

• Reviews insurance claim forms for accuracy and completeness. Makes necessary corrections.
• Demonstrates and applies knowledge of Medicare and Medicaid guidelines in reviewing claims to ensure appropriate use of modifiers and CPT / ICD 10 codes.
• Review medical documentation to confirm appropriateness of codes when necessary.
• Corrects claims appearing on Edit Reports.
• Communicates system and claim formatting issues to the IT department and Billing Manager.
• Serves as a resource to staff on general billing guidelines.
• Demonstrate understanding of business partners' operations to identify appropriate resources for support and information.
• Perform quality checks on data entries prior to submitting information to internal and / or external customers / payers / clients.
• Inform customers / payers of billing problem / issue findings and resolution as appropriate.
• Contact external customers / payers to keep them informed of outstanding balances and required payment, as appropriate.
• Demonstrate and maintain understanding of state and federal regulatory requirements as they apply to billing operations (e.

g., health-care reform; state surcharges; CMS)

• May conduct training (e.g., on-line demonstration; knowledge base; invoice inquiry) to co-workers (e.g., new staff members, collection / cash posting teams) on how to access, review, and / or submit claims for payments.
• Must be dependable and well organized.
• Performs additional duties as assigned.

EDUCATION :

• High school diploma, G.E.D. or equivalent
• Some college education preferred

MUST HAVE REQUIREMENTS :

• 1 year of related job experience.
• CMC, CPC-A Certification
• CPT / ICD 10 codes experience.
• Microsoft Office skills
• Working knowledge of business billing office duties.
• Working knowledge of Medicare, Medicaid, and Managed care.

PREFERRED REQUIREMENTS :

• CPC Certification
• Previous coding experience.
• HMO / managed care, Medicare experience.
• Previous Allscripts, eCW, Athena, and / or RCX system experience.
• PCP and Hospitalist billing and coding experience.
• Bilingual preferred

Last updated : 2024-04-29