Biller Jobs

About The Position

Requirements

• At least two (2) to three (3) years of current experience in an acute care hospital setting, preferred.
• Computer skills preferred.

Nice To Haves

• Experience in an acute care hospital setting.

Responsibilities

• Timely billing and follow-up for all acute care Medicare claims according to State and Federal regulations.
• Review and resolve credit balances.
• Work all denials and/or rejections from the billing work queues timely.
• Submit accurate contractual adjustments and proper documents for each account.
• Input accurate data into Excel spreadsheets.
• Pull data for audits and assist with special projects and/or backlogs within the office.
• Contribute to department operations and communications, behaving in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET patient communication.
• Download CMS/Epremise system daily or as needed.
• Monitor & process credit balances for refunds and transfers in accordance with department procedures.
• Process daily bills via CMS/Epremise system.
• Process claims and bills to payors through bill editor in accordance with department procedures.
• Print Remittance Advices.
• Work on denial accounts daily or as needed.
• Work on daily rejections daily or as needed.
• Work on daily mail and correspondence.
• Work off the work queues and clear ticklers efficiently.
• Maintain quality control on all accounts for correct plan IDs and financial class.
• Update system with appropriate changes.
• Send requests to ancillary departments for reports needed to bill claims in a timely manner.
• Keep current with updates and changes within the Medicare m via CMS website.
• Retrieve any patient information from the HBF system.
• Process daily contractual adjustments.
• Calculate payment and contractual adjustment according to expected reimbursement.
• Work and resolve aged accounts.
• Identify under and over payments.
• Ensure each account has detailed documentation as required by the department procedures.
• Meet productivity requirements daily.
• Provide Medicare RAs to cross over biller.
• Prepare credit balance reporting every quarter to Medicare.
• Demonstrate ability to reach decisions, take appropriate action, and follow through within scope of responsibility.
• Process secondary billing and transfers in accordance with department procedures.
• Perform all other duties and special projects as assigned.
• Maintain basic unit/department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
• Abide by HIPAA regulations.
• Complete and attend monthly training assigned.
• Prepare Pharmacy billing forms for all sub-acute/SNF patients.
• Create and maintain patient files for all information and billing records.
• Prepare and update Drug Order Reference sheets for all sub-acute/SNF patients.
• Obtain Drug Profile for all affected patients from the pharmacy and reconcile with patient records for billing purposes.
• Obtain, update, and reconcile patient census including discharges and admissions with all billing records.
• Obtain and maintain current billing manuals and books.
• Review and reconcile Hospital Drug Formulary with actual items on pharmacy stock to ensure accurate billing of utilized medications.
• Obtain and maintain current prescribing physician’s information including license #s, DEA #s, Telephone contact information etc.
• Prepare and update Drug Price Lists.
• Prepare and perform monthly update of Medi-Cal Drug Provider and policy manual (part 1 & 2).
• Complete and transmit electronic billing for Medi-Cal drug approved medications used by SNF/sub-acute care patients.
• Maintain accurate records of all billings in individual patient files for any review purposes.
• Work with the Pharmacist to complete TAR's for all required drugs utilized by patients.
• Fill out correctly and submit by mail all manual/hard copy drug/pharmacy billing to Medi-Cal.
• Follow up with Medi-Cal office on billing issues to ensure accurate reimbursements.
• Obtain, review, and maintain copies of the remittance advice details and follow-up on any inaccuracies with the Medi-Cal office for resolutions.
• Create and maintain records of total daily billing amounts.
• Create and update Annual Billing totals for each facility.
• Communicate changes in patient/Medi-Cal drug coverage with Pharmacist.
• Obtain supervisory approval to attend relevant posted educational billing seminars to keep up with the current trends.
• Resolve DUR Medi-Cal inquiries with the Pharmacist for affected drugs/patients prior to re-submission of relevant billings.
• Provide Pharmacy check-write to business office Director every Monday.