Job Summary
Medical Billers bill all patient accounts to the appropriate insurance company or payor in an efficient, accurate and timely manner according to payor regulations, and, as appropriate, provide assistance in regard to patient bills, customer (patients, families, physician offices, review organizations, insurance companies) in polite and professional manner. The below Essential Functions are subject to change based on the organizational needs and to ensure with the ever-changing environment of healthcare.
Key Job Duties and Responsibilities
Daily Responsibilities:
- Consistently demonstrates AIDET
- Obtains appropriate insurance and demographic information
- Understands EOBs, billing tickets statuses, and takes appropriate actions accordingly
- Understands claim Edits for claim processing and takes appropriate action accordingly
- Enters quality financial notes into the EMR whenever an action is taken related to an account
- Processes Facility & Professional claims
- Protects patient rights by maintaining strict confidentiality, respecting HIPPA
- Answer incoming phone calls from patients and insurance carriers
- Retrieves and return phone calls
- Processes primary, secondary, and tertiary insurance
- Follows up on insurance requests and accounts receivable
- Verifies eligibility websites and benefits
- Reviews Authorization and Denials
- Submits coding requests to coding
- Communicates with coding department for clarification when needed
- Proficient in utilizing insurance websites
- Follows up on ageing accounts with insurance companies for payment
- Maintains accurate and complete patient accounts
- Voiding/Cloning of tickets when appropriate
- Cross trained to other insurances in order to fill in for coverage
- Creates refunds to the appropriate party
- Completes appeal to insurance companies.
- Insurance follow up reports and electronic queues
- Other duties as assigned
Job Requirements
Required Education and Licenses: none
Required Work Experience:
- Proficiency in Microsoft Excel, email composition, business correspondence, and general office skills is required.
- Knowledge of basic office functions, including message-taking, cash drawer balancing, and data entry.
- Strong attention to detail, ability to follow directions, and excellent customer service skills in an office environment.
- Experience in an office setting and / or medical billing experience.
Required Knowledge, Skills, and Abilities:
- Exceptional customer service, written and verbal communication skills.
- Positive attitude and commitment to the organization’s values and behavioral standards.
- Ability to work collaboratively, exceed expectations, and maintain a professional demeanor.
- Strong problem-solving and critical thinking skills.
- Proficiency with computer systems and multi-line phone systems.
- Adaptability to changing workflows and situations.
Preferred Qualifications:
- Education or experience in medical office work, referrals, or billing strongly preferred.
Functional Demands
Population(s) Served:
This role serves diverse populations, including neonatal, pediatric, adolescent, adult, and geriatric patients, as well as individuals of varying genders, races, ethnicities, abilities, and socioeconomic backgrounds.
Physical Demands:
- Fast-paced office environment requiring multitasking and prioritization.
- Light lifting (<35 lbs.), bending, kneeling, twisting, and reaching.
- Prolonged periods of sitting, standing, and typing.
- Visual and auditory acuity required for effective communication and task completion.
Environmental Conditions:
- Primarily indoors with some exposure to outdoor elements (e.g., snow/ice when entering/exiting).
- Potential exposure to germs and viruses due to public interactions.
