Medicare Biller Collector

Overview

• Reviews and audits accounts located in contract denial management system on a daily basis to resolve and maintain collection status on an account prior to escalating to Team Lead for further review.
• Reviews and processes commercial accounts through contract management system.
• Verifies eligibility, corrects and resubmits claim, and files third party insurances as necessary by adding/updating insurance information within the hospital affiliates.
• Utilizes denial management system and responds to requests from insurance carrier for additional information necessary to process claims.
• Analyzes expected reimbursement information contract management system. Utilizes the system/contract foundation to ensure the accounts are properly paid. Reviews EOB's in contract management system and determines accurate account balance, detailed denial description, and applicable appeal process.
• Identifies and corrects transactions, such as invalid insurance information, incorrect charges, and posting errors, in host system. Posts adjustments in host system.
• Reviews and verifies claim export data in electronic billing, contract/denial management and/or host system.
• Non-Covered Service
• Benefits Exhausted
• Documentation Request
• Information Requested from Member/Beneficiary
• Not Eligible
• Coordination of Benefits/OHI Update
• Work Related Injury/Other TPL Responsible
• Timely Filing
• Claim Deficiency
• Coding/Billing
• Duplicate Claims
• Overlapping Dates of Service/Service Range
• Re-Admission

Qualifications

Minimum Knowledge, Skills and Experience required:

• General application knowledge of EXCEL, WORD, and ACCESS.
• Proven applicable experience working in an environment that utilizes electronic billing, internal report archives, and tools for applicable database management strongly preferred.
• 3 + years working experience of Hospital or Physician office billing and collection processes including producing account appeals with positive outcomes strongly preferred.
• Prefer at least 1 year of supervisory experience strongly preferred.
• Proven applicable experience of preparing complex correspondence to resolve accounts strongly preferred.
• Effective communication skills verbally and written with internal Hospital departments, Physician Offices, Patient, and Insurance payors.
• Must be able to effectively manage a large volume of accounts while maintaining a high accuracy and positive outcomes.

Education:

• High school diploma or GED
• Prefer associates degree from an accredited college with some applicable college courses.
• Prefer applicant with certification in coding, physician office management, or applicable college courses.