Medical Biller I, II, III

Job Title: Medical Biller I, II, III

Department: Patient Accounting

Reports To: Business Office Manager

FLSA Status: Non-Exempt

Wage Range that the Company Expects to Pay:

• Medical Biller I: $25.00 - $27.56 per hour
• Medical Biller II: $27.00 - $29.77 per hour
• Medical Biller III: $30.00 - $33.08 per hour

SUMMARY

Under the direct supervision of the Director of Business Office, the Medical Biller is responsible for utilizing both practice management systems; Athena and NextGen. The employee is responsible for preparing and posting fee tickets for various sites and programs. The Medical Biller will post and balance payments received, handle all incoming billing calls, and work aging for various programs and payers. The employee will send patient statements, run month end reports, and submit third party claims electronically and/or manually. The employee will ensure that all providers and facilities are paneled with the various insurances and state programs. The Medical Biller will maintain current knowledge of CPT, HCPC and ICD10 coding practices. The Medical Biller will also maintain knowledge of all programs and payer sources requirements and guidelines. The employee will adhere to HIPAA guidelines and regulations.

It is the primary purpose of CHCCC to provide the highest quality of total care possible to the patient population it serves. Such a level of quality depends ultimately on the staff's desire and ability to work together, individually, and as a team. The employee is expected to be professional, punctual, maintain regular attendance, be cooperative, organized, and enthusiastic at all times.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Additional duties may be assigned with or without prior notice.

Medical Biller I:

Post daily fee tickets and/or incoming mail for various sites, programs and some specialty services electronically and/or manually. Review fee tickets for accuracy of CPT, HCPC, and ICD10 coding. Check for covered services per payer source to avoid claim denials. Check claims dashboard in Athena and NextGen for any missing fee tickets and check claim worklist inbox for MGR holds. In Athena and NextGen, run missing fee ticket report to ensure that all fee tickets have been posted or voided. Assist patients with billing and insurance questions. Apply payments to charges submitted and balance payment roster. Audit sliding fee payer for accuracy and documentation that supports the sliding fee payment scale. View inbox for billing messages and address patients’ issues. Other duties may be assigned.

Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations.

Maintains and adheres to HIPAA, employee confidentiality, and privileged communications (patient, employee, and corporation).

Demonstrates cultural sensitivity and competence.

Medical Biller II:

Knowledge of Medical Biller I duties and covers when on vacation or out sick.

Reconciles deposits to bank activity to ensure that third party payments are posted and balanced monthly. Submits third party claims electronically and/or manually. Identifies patient reimbursement issues ensuring that claim denials and appeals are efficiently processed and resolved. Work accounts receivable aging report for billing errors, denials, and coding errors and make necessary corrections for reimbursement or bad debt write-off. Run various month end reports to balance monthly billing activities. Other duties may be assigned.

Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations.

Maintains and adheres to HIPAA, employee confidentiality, and privileged communications (patient, employee, and corporation).

Demonstrates cultural sensitivity and competence.

Medical Biller III:

Knowledge of Medical Biller I and II duties and covers when Medical Billers are on vacation or out sick.

Updates and maintains both practice management systems; Athena and NextGen. Process EDI files for dental services in NextGen. Ensure that aging and denial reports are audited ensuring that they are worked appropriately and in a timely manner. Assist billing staff with coding, posting, and claim denials. Ensure that specialty services (impatient/surgeries) are coded correctly for full reimbursement. Set up training curriculums for various job functions (posting, claims denial, procedure codes, diagnosis and modifiers) pertaining to payer(s) guidelines. Knowledge of all payers programs and billing guidelines to ensure accurate coding and full reimbursement. Panel all providers with all insurances using CAQH and Paves.

Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations.

Maintains and adheres to HIPAA, employee confidentiality, and privileged communications (patient, employee, and corporation).

Demonstrates cultural sensitivity and competence.

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

Medical Biller I:

High school diploma or GED equivalent is required. Two years of experience in medical billing and collections. Must be able to establish and maintain effective working relationship with internal and external customers. Must be organized. Computer literacy required.

Medical Biller II:

Same as Medical Biller I plus experience with billing of inpatient services, procedures and surgeries. Knowledge of all billing modifiers, CPT, HCPC coding, and ICD10 diagnosis.

Medical Biller III:

Same as Medical Biller I and II plus experience with report generation, provider insurance paneling, and understanding of denial insurance reason codes and aging report. Help with staff training setup and maintain both practice management systems Athena and NextGen. Transmit dental claims electronically.

LANGUAGE SKILLS

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of an organization. Bilingual in English and another language is preferred, but not required.

MATHEMATICAL SKILLS

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

COMPUTER SKILLS

Experience with word processing, spreadsheets, email, and keyboarding is required. Microsoft Office and Google Suite skills are required. Working knowledge of EHR is preferred. Experience is Athena and NextGen is preferred.

CERTIFICATES, LICENSES, REGISTRATIONS

Possession of current, valid, unrestricted California Driver's License (Class C) required.

OTHER REQUIREMENTS

Required to pass a criminal history background check and drug screen upon hire. Annual health examination; annual Tuberculosis skin test clearance or chest x-ray; proof of immunity to MMR, Varicella, and Hepatitis B; proof of Tdap vaccine; during current flu season, must provide proof of influenza vaccine or a signed declination form. If declined, a flu mask is mandatory during flu season. Health screening requirements are subject to change based on CDC recommendations and federal, state, and/or local public health ordinances.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to sit. The employee is occasionally required to stand and walk. The employee must regularly lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently exposed to moving mechanical parts. The employee is occasionally exposed to the risk of electrical shock. The noise level in the work environment is usually moderate. Must be able to work in a fast-paced environment.

Must be willing to have a flexible work schedule that may include evenings/weekends, and travel as needed.

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified.