Careers

The Medical Biller is responsible for accurately processing inpatient and outpatient claims to third party payers, following all mandated billing guidelines. He/she is responsible for ensuring and meet Timely Filing guidelines. The Medical Biller is dually responsible for all clearing house rejections and edits. The Medical Biller must have the ability to perform all required duties within the patient accounting systems. Skilled in the usage of all Microsoft applications and other programs as defined by the Patient Business Services Management Staff as well as interpretation of payer contracts, processing contractual adjustments, knowledge of late charge process as well as being familiar with HCPCS, CPT and Diagnosis and procedure codes.

Essential Functions & Responsibilities:

• Prepares and submits clean claims to various insurance via electronically or by paper.
• Performs daily claims resubmissions within various client systems and clearinghouse.
• Performs submission of appeals on claims via various web portals.
• Answers questions from patients, clerical staff and insurance companies.
• Evaluates the patient’s financial status and establishes budget payment plans.
• Follows and reports the status of delinquent accounts.
• Reviews account for possible assignment and make recommendations to the Billing Supervisor.
• Prepares medical record review and coding review for inclusion in the submission of all medical claims.
• Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third-party payers.
• Process payments from insurance companies and prepares adjustments on a daily basis in a timely manner.
• Maintain confidentiality at all times.
• Maintain a professional attitude.
• Understand and comply with information security and HIPAA policies and procedures at all times.
• Use, protect and disclose patient’s protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties.
• Report any security or HIPAA violations or concerns to the HIPAA Officers in a timely fashion.

The incumbent performs duties in accordance with performance standards set forth by TCG and the customer. The incumbent may have access to highly confidential customer, patient, employee, and TCG proprietary information, and must handle and protect the information in accordance with institutional and system policies, HIPAA requirements, and with the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, and other security risks to the organization. The incumbent is accountable for employee safety and will attend safety and loss-control training, engage in injury prevention, perform accident and injury investigations including conducting root cause analysis and assist in returning employees to regular duty. The incumbent is responsible for participating in and completing all patient safety initiatives appropriate to the position and conducts all job responsibilities according to the Mission and Values of TCG and the customer.[/vc_column_text][/vc_column_inner][/vc_row_inner]

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