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Managed Care/Commercial Biller

Company: Hirebridge Organic
Location: Oak Park
Posted on: May 12, 2022

Job Description:

Job Description Job Title: MANAGED CARE/COMMERCIAL BILLERJob Summary: Responsible for billing all Non-Government claims accurately and timely. Must have knowledge in Government and State billing laws. Knowledge in CPT,ICD-9 and HCPCS codes is a requirement. Submit re-bills for corrected claims, and work billing denial reports within 24 hours from our clearing house systems. Required to document accounts financial systems accurately and timely. Reports To: Managed Care Manager and or Revenue Cycle Director/ManagerEssential Job Duties: · Demonstrates competency and knowledge in managed care insurance billing, collections and contracts.· Reviews and updates accounts with correct payor codes, insurance addresses and financial classes.· Responsible to request medical records for billing purposes in a timely manner.· Knowledge in billing and or re-billing of claims through E-premis.· Demonstrates competency and knowledge in billing secondary plans. · Knowledge in billing cost pass thru invoices and late charges.· Demonstrates ability to identify and correct any missing information on claims.· Demonstrates ability to identify missing charges and request a detailed audit on claims. · Ability to document in Paragon system with account activity.· Ability to combine charges when needed on system.· Demonstrates ability and knowledge in resolving outstanding balances owed on managed care claims. · Demonstrates knowledge and understanding of managed care contracts. · Ensures contractual discounts are applied to accounts as specified in each contract.· Able to apply contract language to each claim as needed for reimbursement calculations/Review Explanation of Benefits.· Knowledge and experience working with Microsoft Word and Excel programs to create spreadsheets when necessary.· Ensures contractual adjustments are submitted timely by month end, including capitated accounts. · Work correspondence and emails timely (within 48 hours)· Retrieve necessary documents in the HBF system for billing· Demonstrates full knowledge on interpreting an Explanation of Benefits and identify patient financial responsibility.· Knowledge and experience in processing refund requests. · Notifies supervisor of any issues or problems.· Consistently meets billing goals per department guidelines.· All other duties and projects as assigned.Behavioral Standards: · Exhibits customer and service oriented behaviors in every day work interactions.· Demonstrates a courteous and respectful attitude to internal workforce and external customers. · Communicates accurately and appropriately.· Works well and efficiently under minimal supervision.· Handles difficult situations in a discreet and professional manner.· Is adaptable to changes in assignments and priorities.Communication/Knowledge: · Provides accurate and timely written and verbal communication of information in a manner that is understood by all. · Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome. · Able to use IT systems in an accurate and proficient manner.Collaboration/Teamwork:· Contributes toward effective, positive working relationships with internal and external colleagues.· Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization. Education/Experience:· High school graduate or equivalent required· Prefer at least 2 to 3 years of current experience in an acute care hospital setting · Must be able to multi-task and work in a fast past environment· Licensure/Certifications:· N/AADA/Physical Demands:· To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.· Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell. The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.

Keywords: Hirebridge Organic, Oak Park , Managed Care/Commercial Biller, Other , Oak Park, Illinois

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