Lead Insurance Biller

SUMMARY AND ESSENTIAL FUNCTIONS: 

Lead biller will act as an immediate resource for the general work area and assist in projects as assigned. The biller is also responsible for the timely and accurate filing of all patient billings. All billing must be billed according to payer requirements. Will utilize the most expedient means available to deliver such billings to each payer. This position reports to the PFS Director. The biller also assists Management in monitoring bills that may fall below benchmarking for clean claims submission and other standards as assigned. Each biller is required to report / document all ongoing edit failures to their immediate supervisor. Responsibilities include other duties as assigned, and overtime as requested or required.

• Reviews critical information for the billing processes, including quality control audits, and reports the results to Management.
• Communicates in a clear and understandable manner using appropriate verbal and non-verbal styles.
• Maintains knowledge of various insurance data element requirements, as well as the impact on revenue cycle operations.
• Serves as the gatekeeper for reporting edit failures that impact or contribute negative results for the clean claim standards for the hospital.
• Greets all guests/customers with a positive and professional attitude.
• Answers incoming phone calls and follows through to address inquiries in a professional and timely manner.
• Understands and applies philosophy and objectives, and revenue cycle policies and procedures, as related to assigned duties. 
•  Reviews, analyzes, and works from various system reports, as assigned.
• Maintains confidentiality of patient health information (PHI), in accordance with policy, HIPAA and other regulations.
• Provides assistance with various types of compliance reviews and departmental projects.
• Communicates with and obtains assistance from various types of governmental and regulatory agencies, regarding the interpretation of critical regulations and procedures that affect the billing process. Reviews insurance bulletins, government regulations and miscellaneous information upon receipt for changes affecting the billing process. Responsible for recognizing how our changing healthcare industry and the related trends may impact the region’s revenue cycle operation and responding appropriately.
• Establishes appropriate work priorities and completes work assignments in an accurate and productive manner, within designated timeframes.
• Regularly reports the results of work-related efforts that include accomplishments, key opportunities, as well as critical issues.
• Maintains expected proficiency levels in data entry skills (min. 40 wpm) and system application expertise.
• Observes work hours and provides proper notice of absences, and work schedule changes.
• Maintains courteous and cooperative working relationships with management, patients, physicians, other professional contacts, and the general public. Demonstrates ability to tactfully handle difficult situations, through an approach that reflects consistency and fairness.
• Presents a well-groomed and professional image, in compliance with the departmental dress code.
• Attends and actively participates in various meetings, at the request of Management.
• Performs other duties within the established timeframes, as assigned.
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• Responsible for filing insurance claims for all third-party payers in a timely and accurate manner.
• Ensures that goals and objectives established in conjunction with patient account manager are attained.
• Files and collates all forms associated with the maintenance of accurate master files, either paper or electronically. 
• Mails appropriate forms to payers and/or patients.
• Inputs computer information for electronic processing and edits of eligible claims.
• Analyzes edit reports; identifies and rectifies problems to ensure timely and accurate reimbursement. 
• Reviews insurance return mail and determines reasons for return. (Notifies others as appropriate).
• Reviews bills for accuracy of charges by comparing diagnosis or procedures to charges.
• Enters accurate and thorough documentation (and corrections as needed) in patient accounts or otherwise in the information systems. Documents thorough explanatory notes on patient accounts, concerning any non-routine circumstances, clarifying special billing / collection processes.
• Works correspondence daily, accurately and timely.
• Works assigned accounts daily and maintains required production levels per day.
• Review final bills / late charge reports and apply late charges accurately according to established procedures.
• Research claims denied / pended and take timely and corrective action.
• Demonstrates understanding of MSP billing rules and submits bills appropriately.
• Obtain a pre-certification number for claims submitted without one.
• Follows Medicare billing guidelines, as well as the 72-hour rule.
• Reviews bills for accuracy of charges by comparing diagnosis or procedures to charges. 
• Lead biller acts as an immediate resource for their general work area.
• Lead biller’s responsibilities also will be to engage in projects as directed.

REPORTS TO:  PFS Manager

SUPERVISES:  None

QUALIFICATIONS: 

Minimum of one-year experience as an insurance biller, in a medical facility or Minimum of one year experience with the various business office processes, such as bad debt, payer requirements, and must be able to understand and interpret payer explanation of benefits. Proficiency in operation of computer terminal and personal computer equipment.

Strong interpersonal, analytical, problem-solving with a “take charge” attitude. Must be comfortable interacting with various management levels. Typing or data entry competency of 40 words per minute. Demonstrated professionalism and flexibility to work schedules based on need. Experience with MS Word, Excel preferred but not required. 10-key touch adding machine skills.

Salary : $21 - $29