Biller - Inpatient/Outpatient (Remote / Hybrid Opportunity)

Opening Full Time 40 hours Grade 007 Patient Financial Services Responsibilities Position Summary: The Biller-Inpatient/Outpatient is responsible for the accurate and timely preparation and submission of third party billing/claims to governmental or third party payers.
Re-submits claims that fail third party edits and submits second level claims.
Provides guidance and support to PAO Billing Assistant and answers correspondence.
The Biller will represent the department and Strong Memorial Hospital (SMH) in a professional manner, protecting confidentiality of patient information at all times.
Supervision and Direction Exercised: Responsible for monitoring own performance on assigned tasks against procedure standards.
May train and coordinate activities of peers as directed by Operations Supervisor and Manager.
Machines and Equipment Used: Standard office equipment, including but not limited to: telephone, photocopy machine, adding machine, personal computer (for claims inquiry and entry software) fax/scanner, Flowcast billing application, Microsoft Word, Excel, Access, Email, Emdeon (Fidelis Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems (ePaces, Omnipro) and various payer web sites.
Typical Duties 35% Researches and corrects primary payer claims that have failed to process.
Using knowledge of payer billing software makes corrections directly in payer system.
Identifies non-routine problems for claims requiring correction and decides action for correction by reviewing bill types and interpreting visit notes.
Resolves non-routine upfront edits on Emdeon which include but are not limited to modifier requirements or provider enrollment issues.
Identifies claims that require further research and determines source of correction and initiates request through PAO supervisors or appropriate clinical department.
Tracks pending claims and makes appropriate correction once answer has been received.
Notifies the team Operations Supervisor when the amount of edits holding exceeds normal target ranges.
Prepares written summary of the issues regarding the edits.
Documents all actions thoroughly in visit notes.
30% Submits secondary payer claims.
Prepares paper claims for secondary submission using knowledge of secondary payer unique requirements and processes.
Provides primary payment information and determines adjustment information and applicable details required for each claim.
Determines when a 'no-pay' claim request must be submitted to a primary payer in order to obtain a denial sufficient to be sent to the secondary payer.
Reviews claim data and modifiers as well as secondary payer and patient requests prior for appropriateness of secondary payer submission.
Compares primary payment to the anticipated secondary payment to determine whether or not to follow secondary payer submission process.
Using knowledge of payer rules submits secondary bills after confirming that an additional payment is due.
Resolves non-routine upfront edits on Emdeon which include but are not limited to modifier requirements or provider enrollment issues.
Identifies claims that require further research and determines source of correction and initiates request through PAO supervisors or appropriate clinical department.
Tracks pending claims and makes appropriate correction once answer has been received.
Documents all actions thoroughly in visit notes.
30% Corrects claim errors returned post-submission.
Reviews claims requiring non-routine correction in payer system to determine method of correction.
Adjusts claims through manual process to ensure highest level of reimbursement.
Determines cause of error to identify appropriate source that can supply applicable missing information (e.
g.
modifiers, medically unlikely edits).
Tracks pending claims and makes appropriate correction once answer has been received.
Identifies the correction method needed when additional modification of a claim triggers an additional edit.
Finalizes claim submission following resolution.
10% Other duties as assigned: Provides guidance and support to Billing Assistants Manually keys/ enters late charges on 141 bills in Omnipro Answers correspondence Expectations: Participate in department/team staff meetings, educational classes and training Attend monthly department and team staff meetings Stay up to date on HIPAA guidelines through education and reading monthly emails Participate in educational training such as Strong Commitment ICare and Annual In Service Join PAO committees such as planning PAO events or addressing employee issues Attend weekly meetings Qualifications: Requires: Associate's degree in Accounting and 1 year of related accounting or collection experience; or an equivalent combination of education and experience.
NOTE: This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.
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This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.
How To Apply All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled Pay Range Pay Range: $ 17.
00 - $ 23.
08 Hourly The referenced pay range represents the minimum and maximum compensation for this job.
Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined byconsidering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.