Billing Associate II

SUMMARY

The Billing Associate II is responsible for follow-up on accounts as assigned by the Assistant Manager, to ensure all claims have been appropriately billed within 30 days and brought to resolution within 60 days. Responsible for the analysis and follow-up of denied claims, file appeals when appropriate, process carrier inquiries (both written and oral) and initiate refunds when necessary.

Works under general supervision following established protocols and procedures. Maintains confidentiality of all information. Reports to Sr. Manager.

ROLE RESPONSIBILITIES

Reviews and maintains billing processes to establish timely cash collections with the payer

Analyzes accounts daily to ensure all claims are worked within 30 days and target goal, as set by Sr. Manager, is met

Audits delinquent and aging insurance claim reports, researches and reconciles outstanding accounts to resolve issues and determine if adjustment, correction, or rebilling should take place. Follows through with third party payers to resolve payment issues and ensure timely receipt of payments

Determines appropriate judgment on claims over 60 days old

Retrieves all medical documentation and initiates appeal process when appropriate

Determines when payer refund is necessary and initiates paperwork

Seeks ways and opportunities to increase productivity and efficiency, while maintaining or improving quality

Acts as a liaison between practices and the billing office to ensure timely resolution to inquiries

Identifies and directs, based on payer policy guidelines, all requests for write-offs to management for approval

Initiates contact with provider reps when appropriate to resolve difficult claim issues

Performs related duties as required in support of dept operations

Demonstrates knowledge of the population-specific differences and needs of patients in appropriate, specific populations from neonate through adolescence and applies them to practice.

Demonstrates cultural sensitivity in all interactions with patients/families and co-workers.

Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CCMC STANDARDS

EDUCATION and/or EXPERIENCE REQUIRED

Education Required: High School Diploma, GED, or a higher level of education that would require the completion of high school, is required

Experience Required: 3 years professional billing experience

LICENSE and/or CERTIFICATION REQUIRED

Certification in medical coding preferred

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

KNOWLEDGE OF

ICD-9, CPT, and medical terminology preferred

Basic knowledge of payer policies and claim billing

Basic knowledge of Microsoft Word, Excel

SKILLS

Must have excellent customer service skills

Excellent written and verbal communication skills

ABILITY TO

Prioritize multiple tasks to ensure all responsibilities of position are addressed in a timely manner