Insurance Verifier/Biller-Full Time

Clarkston Surgery Center is a well-established ambulatory surgery center (ASC) that has been in operation since 2009. Its highly trained staff are dedicated professionals committed to fostering a positive and supportive work environment. The center provides exceptional surgical services and continually strives to improve quality and patient care. By focusing on key processes, the team works to meet - and exceed - the expectations of patients, their families and the physicians they support.

JOB SUMMARY:Verify insurance benefits and calculate the patient's estimated financial responsibility. Submit medical claims to insurance companies, ensuring accuracy and completeness in billing and coding.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Verify insurance coverage and eligibility.
• Calculate patient out-of-pocket liability (copay, coinsurance, deductible). Contact patient/guarantor to arrange payment.
• Accurately enter all information into patient accounting system.
• Obtain required pre-authorizations in accordance with payer guidelines.
• Create and submit accurate medical claims for surgical procedures to insurance carriers.
• Follow up on denied or unpaid claims; determine the reason for denial and initiate appeals with appropriate documentation to secure payment.
• Respond to billing inquiries from patients and insurance companies; resolve any complaints related to billing.
• Stay current with healthcare regulations, HIPAA, and coding standards to ensure compliance.
• Adhere to all facility policies, procedures and standards.

QUALIFICATIONS:

• Proven experience in medical billing, with a preference given to experience in an ambulatory surgical center (ASC).
• Proficient in medical billing software, such as SIS and Waystar.
• Strong understanding of medical terminology and coding systems, including ICD-10 and CPT.
• Exceptional accuracy and attention to detail in data entry and claims processing.
• Excellent written and verbal communication skills.
• Strong critical thinking and problem-solving abilities to address billing issues and denials.
• Ability to work independently while managing workload, and to collaborate effectively as part of a team.
• Must be adept at handling multiple tasks in a fast-paced environment.

SUPERVISORY RESPONSIBILITIES: N/A

OTHER DUTIES AND RESPONSIBILITIES: As assigned by the Business Office Manager

PHYSICAL DEMANDS / WORKING CONDITIONS:

Working environment reflects the essential functions of the job. Physical demands require employee to sit and be on the phone for extended periods of time. Reasonable accommodations may be made to enable individuals to perform essential functions.

BENEFITS:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Health insurance
• Health savings account
• Life insurance
• Paid time off (PTO)
• Vision insurance

Schedule:

• 8-hour shift
• Monday to Friday

Education:

• High school diploma or equivalent

Experience:

• Health care: 2 years (Required)
• Insurance verification and estimates: 1 year experience (Required)
• Medical claims billing: 1 year (Required) - ASC experience preferred
• Intermediate computer proficiency: Microsoft Office and SIS Complete experience preferred.

Supplemental pay types:

• Bonus pay

Work Location: Clarkston, Michigan

Work Remotely: No