PROFESSIONAL BILLER

Covenant HealthCare • Saginaw, MI

5d

About The Position

The Professional Biller is responsible for prompt, accurate billing and follow-up for hospital and related professional services provided to patients covered by third-party payers, including Medicare, Medicaid, Blue Cross, commercial insurers, workers’ compensation, and managed care programs. The role secures timely and accurate reimbursement from payers and patients through appropriate billing and follow-up activities. The biller is expected to provide excellent customer service consistent with Covenant’s Vision, Mission, and Values and its commitment to Extraordinary Care for Every Generation.

Requirements

• Some post-high-school education; accounting, information systems, or third-party billing education is preferred.
• At least 18–24 months of relevant work experience or an equivalent combination of training and relevant work experience.
• Strong working knowledge of departmental policies, procedures, business operations, and how they relate to other departments.
• Knowledge of third-party billing and collections.
• Basic understanding of UB-94, Form 1500, CPT, and ICD-9 coding.
• Knowledge of hospital and/or medical billing and insurance claim filing.
• Experience or knowledge in insurance and/or account follow-up.
• Knowledge of medical and insurance terminology.
• Typing speed of at least 35 words per minute.
• Clerical skills, including 10-key, computer, telephone, and copier use.
• Good written and oral communication skills.
• Ability to work independently and as part of small or large teams.
• Ability to protect and maintain the confidentiality of information.

Nice To Haves

• Associate degree preferred.
• Strong working knowledge of Excel, Word, and PowerPoint preferred.
• Hospital billing and insurance claim processing experience preferred.
• Insurance and/or account follow-up techniques experience preferred.

Responsibilities

• Resolve patient billing inquiries and problems, and follow up on balances due from insurance companies and patients.
• Assist patients and families with account questions or concerns about payment, reimbursement, and payment contracts.
• Perform insurance billing clerical duties, including reviewing and verifying patient account information against payer program specifications.
• Enter charges, payments, denials, and adjustments electronically.
• Understand the revenue cycle.
• Maintain knowledge of Federal, State, and local billing regulations and inform management and the compliance department of discrepancies.
• Complete and submit electronic or hard-copy claims, including initial billing, insurance re-billing, and secondary or subsequent billings.
• Ensure accuracy and third-party compliance in billing activities, including clinical attachments, CPT coding, occurrence, condition and value codes, pre-certification, contractual adjustments, and required forms.
• Adhere to applicable rules and regulations and respond promptly to changes communicated by insurance carriers, employers, third-party payers, or government agencies.
• Conduct timely and thorough claims follow-up to help reduce days in accounts receivable and payer turnaround time.
• Maintain an understanding of HMO, PPO, and managed care contractual relationships and determine whether payments and adjustments are correct.
• Identify credit-balance accounts and determine the appropriate recipient or destination for refunds or transfers.
• Report repeated errors or omissions in patient insurance and demographic information to the manager.
• Correct claims edits or errors promptly and before submission.
• Prioritize issues and workload effectively.
• Work effectively as a team member and one-on-one.
• Communicate effectively verbally and in writing.

Benefits

• Comprehensive medical, dental, and vision coverage.
• Retirement plans with employer match.
• Paid time off.
• Employee wellness programs and mental health support.
• Tuition reimbursement, university discounts, and professional development opportunities.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree