Insurance Claim Biller

POSITION SUMMARY

(General statement reflecting the overall purpose of the position)

Humboldt General Hospital is looking for an experienced Insurance Claim Biller familiar with claim submissions to insurance companies and experience working with SSI. This candidate will be responsible for submitting correct or self-corrected claims, working patients encounters via established work queues and communicating and coordinating with revenue cycle colleagues. Attention to detail and superior customer service skills is necessary.

TASK LETTER CODE

PRIMARY DUTIES

(Are the essential job tasks or primary responsibilities that the individual who holds the position mist be able to perform unaided or with the assistance of an accommodation. For example: “DO” (action verb) “WHAT” (object) – “Collects vitals from patients at the being of the visit according to clinic protocol”.

% OF TIME PERFORMING DUTY

A

Submit correct clean claim to payors, or submit correction, of UB and/or 1500 claims forms. Review and process claims in various stages of revenue cycle in a timely manner.

B

Resolve encounters assigned via work queues and apply action when appropriate

C

Review claim edits from front and back-end scrubbers to reduce denials

D

Review edits received from SSI, correct claim and regenerate as appropriate.

E

Receives and takes calls from patients with insurance information updates such as COB

F

Receive, and take, Inbound and outbound calls with government payors and commercial insurance payors

G

Prepare and file insurance appeals in a timely manner

H

Work AR as assigned.

I

Modify charge grouping and registration when necessary for proper claim submission

J

Manage SSI web portal to include generating reports, working timely filing claims and troubleshooting claim submissions. Identify and log trending claim denials.

K

Maintains confidentiality adheres to all HIPAA guidelines/regulations

L

Other related duties as assigned.

M

N

O

POSITION QUALIFICATIONS

MINIMUM EDUCATION: High School diploma or General Education Degree

PREFERRED EDUCATION:

MINIMUM EXPERIENCE: Basic knowledge of third-party insurance plans billing.

REQUIRED CERTIFICATIONS:

PREFERRED CERTIFICATIONS/LICENSES: CRCR

SPECIAL SKILLS:  Cerner Community Works/Revenue Cycle and SSI experience is preferred. Excellent command of written and spoken English; must be able to communicate effectively when in contact with insurance carriers, third-party payers and patients. Must be able to learn and understand patient accounting policies and procedures and how the EHR computer system works. Intermediate knowledge of Microsoft Word and Excel and the ability to learn new programs and systems is necessary. Dependable in both productivity and attendance.

SUPERVISES: None

PHYSICIAL DEMANDS: For physical demands and working conditions, see next page.