Clinic Billing Representative

The Medical Billing Representative position bills insurance companies for all clinic claims and physician bills; pursues collection of all claims until payment is made by responsible parties; purses uncollected monies from insurance companies through zero balance audits; and performs other work associated with the billing and collection process.

Essential Functions

Prepares and submits medical claims to third-party insurance carriers either electronically or by hard copy.
Follows up with third-party insurance carriers and patients until claims are paid.
Monitors claims for missing information and authorization/control numbers.
Reviews accounts that are at a zero balance to analyze if money was left uncollected by clients. If under-collection is identified, files appeal to collect underpayment.
May be called upon to serve as a representative in meetings and communications with clients and payers.
Looked upon to serve as a lead in a specific billing area.
Secures needed medical documentation required or requested by third party insurances.
Processes rejections by either generating a letter of rejection to patient or correcting any billing error and resubmitting claims to third-party insurance carriers.
Works with coders to ensure that correct diagnosis/procedures are reported to third party insurance carriers.
Notify patients when claims have not been paid after time frames in established accounts receivable policy.
Keeps updated on all billing and benefit changes for third-party insurance carriers.
Knowledge of governmental billing regulation and guidelines.
Ability to bill Inpatient and Outpatient governmental and commercial claims.
Audit accounts to ensure that appropriate payments are paid by responsible parties.
Posts third-party insurance remittance vouchers and all other forms of payment.
Maintains confidentiality of all information.
Completes work within authorized time to assure compliance with departmental standards, including meeting production and quality standards.
Demonstrates knowledge of, and supports, both client's and SCHCD's mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
Performs other duties as required.

Competencies

Athena experience preferred
Stress Management/Composure
Results Driven
Technical Capacity
Problem Solving/Analysis
Customer/Client Focus
Teamwork Orientation
Collaboration Skills
Time Management
Communication Proficiency

Experience

2 years experience in the medical office billing environment required
5 years experience in the medical office billing environment preferred