What are the responsibilities and job description for the Medicare Biller Collector position at HH Health System?
Overview
- Reviews and audits accounts located in contract denial management system on a daily basis to resolve and maintain collection status on an account prior to escalating to Team Lead for further review.
- Reviews and processes commercial accounts through contract management system.
- Verifies eligibility, corrects and resubmits claim, and files third party insurances as necessary by adding/updating insurance information within the hospital affiliates.
- Utilizes denial management system and responds to requests from insurance carrier for additional information necessary to process claims.
- Analyzes expected reimbursement information contract management system. Utilizes the system/contract foundation to ensure the accounts are properly paid. Reviews EOB’s in contract management system and determines accurate account balance, detailed denial description, and applicable appeal process.
- Identifies and corrects transactions, such as invalid insurance information, incorrect charges, and posting errors, in host system. Posts adjustments in host system.
- Reviews and verifies claim export data in electronic billing, contract/denial management and/or host system.
- Non-Covered Service
- Benefits Exhausted
- Documentation Request
- Information Requested from Member/Beneficiary
- Not Eligible
- Coordination of Benefits/OHI Update
- Work Related Injury/Other TPL Responsible
- Timely Filing
- Claim Deficiency
- Coding/Billing
- Duplicate Claims
- Overlapping Dates of Service/Service Range
- Re-Admission
Qualifications
Minimum Knowledge, Skills and Experience required:
- General application knowledge of EXCEL, WORD, and ACCESS.
- Proven applicable experience working in an environment that utilizes electronic billing, internal report archives, and tools for applicable database management strongly preferred.
- 3 years working experience of Hospital or Physician office billing and collection processes including producing account appeals with positive outcomes strongly preferred.
- Prefer at least 1 year of supervisory experience strongly preferred.
- Proven applicable experience of preparing complex correspondence to resolve accounts strongly preferred.
- Effective communication skills verbally and written with internal Hospital departments, Physician Offices, Patient, and Insurance payors.
- Must be able to effectively manage a large volume of accounts while maintaining a high accuracy and positive outcomes.
Education:
- High school diploma or GED
- Prefer associates degree from an accredited college with some applicable college courses.
- Prefer applicant with certification in coding, physician office management, or applicable college courses.