The Biller / Collector II is an Accounts Receivable function. To perform this job successfully, an individual should be able to perform each assigned essential duty satisfactorily. This position is expected to have excellent reasoning skills based on knowledge of clinic operations as it pertains to billing claims to Insurance Health Plans, coding for medical diagnosis and procedural coding. Individual must be familiar with the conventions and instructions provided within the ICD disease classifications and CPT coding guidelines. Should be able to reason through insurance claims differences as defined by benefit and plan differences. This position is responsible for resolution of A / R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including local, state and federal regulations regarding billing and collection practices are followed, as well as with established internal policy and procedure. Additionally, this position may be responsible for any or all of the following: acting as a resource to other staff and clinics, timely billing or filing of claims for services rendered at the clinics, reviewing claims that are rejected / denied / not paid for errors or incorrect filing with the Carriers and Medicare, billing patients and collecting for fees deemed to be the patient's responsibility, billing secondary insurance, data entry of encounter data (or fee tickets) from the Clinics, and Evaluation and Management Documentation Guidelines. Primary Responsibilities:Review medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filedVerifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation (Biller)Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance informationResponsible for working EDI claim rejections in a timely mannerReceives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, Medicare, or patients. Able to apply correctly to claims / fee billed (Collector)Processes incoming EOBs to ensure timely insurance filing or patient billing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insuranceResponsible for processing payments, adjustments and denials according to established guidelines (Payment Poster)Responsible for reviewing insurance payer reimbursements for correct contractual allowable amountsResponsible for reporting payer payment and denial trends in a timely fashionResponsible for reconciling transactions to ensure that payments are balancedResponsible for reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and proceduresResponsible for keeping current with changes in their respective payer's policies and proceduresCommunicates with the Clinics to provide or obtain corrected or additional dataAble to prepare documents for training or for establishing procedures for clinicsIdentifies problems and root cause of problems related to billing and collectionsAssist with training materials and training staff membersResponsible for identifying problems / trends in medical documentation and reporting them in a timely fashionAnswers patient and customer questions regarding billing and statementsPrepare claims for encounters with complex progress note issuesParticipates with special assigned projectsPerforms all other duties as assigned
Required Qualifications:High school diploma or GED equivalent4 - 5 years of relevant medical experienceStrong attention to detail and professional customer service skillsProficiency with Microsoft Office applications Preferred Qualifications:Medical terminology and ICD / CPT coding Technical skills in the areas of EDI, systems analysis and process flows2+ years of related billing and / or collection experienceCoding certification50 wpm typing skillKnowledge of submission and resubmission of medical claimsKnowledge of government and commercial policies and proceduresKnowledge of ICD, CPT codes and HCPCS codingKnowledge of HIPPA compliance rules and regulationsSkill in the operation of billing software and office equipment Skill in using Microsoft Office (Outlook, Excel, Word)Skill in processing claims efficiently and on a timely basisSolid customer service skills and excellent interpersonal skillsAttention to detail Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Biller, San Antonio, TX, Texas
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.