Non Governmental Biller

KPC GLOBAL MEDICAL CENTERS•Hemet, CA

38d•Onsite

About The Position

Performs third party billing for non-governmental third-party payers including traditional commercial insurance carriers, Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), EPO's, International Payers, Auto Liability and other Liability carriers, and all other non-governmental third-party payers. Duties include billing and ensuring claims go out on a timely manner to the appropriate payers.

Requirements

Minimum 2 years’ experience in a hospital setting.
Knowledge of CPT, HCPC’s, HIPAA, UB04, Compliance and Regulatory issues.
Knowledge of billing systems and software applications.
Sitting and standing for prolonged periods.
Arm and hand dexterity.
Must have command of close and distant sight, color perception and hearing.
Ability to lift and move up to 25-pounds.

Nice To Haves

Some college preferred.

Responsibilities

Ensuring timely submission of non-governmental claims in the billing editor.
Preparing and submitting primary and secondary claims using the billing editor software to submit claims electronically or hardcopy, ensuring all edits are worked in a compliant manner based on directives given by management.
Preparing and submitting complex claims including split bills, interim bills, benefits exhaustion, etc.
Monitoring billing editor for correct claim edits and reporting findings to management to make edit corrections.
Reconciling complex accounts, i.e. split payments, interim claims, benefits exhaustion, etc.
Ensuring all charge and coding related issues are clearly identified and entered in the HIM/Charge audit spreadsheet for clarification and resolution.
Following up to ensure timely response from others and ultimate resolutions.
Identifying payer trends and reporting to management providing input on appropriate steps to take.
Maintaining productivity levels within guidelines established by management.
Documenting clearly and succinctly in account notes all action taken on account, i.e., phone call numbers, representatives spoken to, corrective action taken, referrals made and specific claim submission details as appropriate.
Performing duties with little or no errors.
Reviewing 72 hour report to capture possible overlap issues prior to the claim being billed out.
Working rejected claims on the billing software on a daily basis.
Completing Late Charge report accordingly.
Performing other duties as assigned.