Managed Care/Commercial Biller
Company: Hirebridge Organic
Location: Oak Park
Posted on: May 12, 2022
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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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