Medical Biller - Pediatrics

Medical Biller - Pediatrics

Join a company where physicians and staff are dedicated to delivering high value care to every patient, and where employees are appreciated for their positive impact on the patient experience.

Responsibilities:

• Minimum of 5 years’ experience in Pediatric Billing with heavy emphasis on CMO’s and commercial payer claim submissions.
• Solid understanding of billing rules surrounding ages and stages of child well visits and services included with Early and Periodic Screening Diagnostic and Treatment visits.
• Superb attention to detail. Keen attention to detail and know where to find commonly used practice codes.
• The ability to correct front end billing edits by understanding insurance rules for submitting clean claims.
• Solid understanding of CPT codes and Modifiers associated with visit levels.
• High level of understanding of payer rankings and COB rules, to enter insurance payers into the practice management system. Preferably Athena Health
• Work in collaboration with front office team to collect patient balances, answer billing questions from staff and patients regarding insurance filing and/or patient account balances.
• Good Communication skills. Must possess confidence about payer guidelines and rules when interacting with a variety of people including providers, patients, and insurance companies. The ability to analyze a problem and explain resolution and next steps to the payer and patient is essential in this position.
• The ability to work rejected claims (minimum 40-50 per week) is essential to keeping claim bucket under targeted goal.
• Identify and resolve insurance/patient billing complaints.
• Review rejected and/or denied claims, make corrections, and resubmit clean claim within the required time frame.
• Work Claims List and Hold Buckets. Ensure all documents are submitted for proper billing: office notes, etc.
• Identify billing trends or suspected problems with carriers and report findings to immediate supervisor.
• The ability to run daily and monthly reports as directed by the Department Manager.

Required:

• Athena Health experience preferred.
• This is NOT a remote position.
• CPT and ICD-10 coding, charge entry for physician office billing, in-depth knowledge of insurance billing and follow up.
• Knowledge of CPT II codes with their relation to Quality Measures.
• Knowledge of CPT, HCPCS and ICD-10 codes; familiarity with regional and national payers (including Medicaid, Medicare, Medicare HMO and Commercial HMO, PPO and POS).
• Minimum of 3 years of comprehensive medical billing, collection and insurance experience in medical office required, customer service focus is mandatory, previous experience on medical practice manager software and electronic medical record software required. Should be proficient with MS Office (Word, Excel, Outlook) and have experience working in multiple billing software systems.
• Certificate of Completion of a Medical Office Billing Technical School or Associate Degree Preferred.

Benefits:

• Paid time off for vacation and sick time
• Paid time off for birthday after one year of employment
• Paid holidays
• Medical Insurance
• Dental Insurance
• Vision Insurance
• 401 (K)
• Employee Assistance Program

Schedule:

• 8-hour shift
• Day shift
• Monday to Friday

Work setting:

• Medical office

Experience:

• ICD-10: 1 year (Preferred)

Work Location: In person

Salary: $20.00 - $23.00 per hour

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