Insurance Biller & Coder

Description

Provides insurance billing, coding, and administrative support for assigned units. The incumbent will interpret and assign correct procedure and billing codes to claims for processing, ensure accuracy, and work to resolve billing discrepancies, and collect unpaid claims, working in Electronic Medical Records systems such as PCE, Nextstep and/or Extended Reach, private insurance companies, and Medicaid. This position will support administrative functions, which may include organization and tracking of administrative and clinical information for Agency and State purposes, data entry, and assisting with case file organization and case-related activities

Requirements

• Maintains proper documentation for compliance purposes and for accurate reimbursement.
• Obtains, records and monitors required authorizations for payment to be received.
• Processes patient insurance claims by reviewing the charges and ensuring the proper insurance information is provided to the insurance carrier. Enters billings. Corrects any claims and advises leadership staff of any steps to be taken to remedy problems.
• Collaborates with workers, clients, and insurance carriers to resolve claim rejections or claims that have been pended for payment.
• Collaborates with leadership staff and clinical staff in the correct procedure codes to be utilized for maintaining compliance with payer reimbursement policies and governmental regulations.
• Proactively researches and resolves discrepancies in billing and related data
• Processes/posts payments; compiles reports and summaries.
• Performs credentialing of new staff in assigned units.
• Posts payments to client accounts. Utilizes the insurance carrier's payment records to create the deposit and ensures the payments and deposit are in balance.
• Responds to questions from clients and insurance carriers regarding their current bills.
• Verifies client Medicaid eligibility
• Utilizes critical thinking and analytical skills to solve problems, create efficiencies and innovation
• May performs general accounting skills while posting payments and other related functions.
• May create and maintain spreadsheets for use in data reporting and tracking.
• Provides administrative support as assigned, which may include main desk responsibilities, preparing contractual billings, maintaining databases, data entry, maintaining records, opening, and closing client cases, tracking unit productivity, using a variety of office software.

Perform other job-related duties as assigned

QUALIFICATIONS

• Excellent organizational skills, critical thinking, problem-solving, and analytical skills.
• Self-motivated.
• Ability to work independently and prioritize multiple tasks while maintaining detail accuracy.
• Effective communication and customer service skills and the ability to work well with and within diverse group of people.

EDUCATION and/or EXPERIENCE

Required:

• High School diploma/GED
• Three (3) years relevant training/experience in insurance billing/coding
• Must be proficient in Microsoft Office (Outlook, Word, Excel, etc.) and database navigation
• Trained or willingness to be trained in First Aid, CPR, and AED

Preferred:

• Office administration experience
• Certified Professional Coder
• Experience in Streamline or other EMR systems
• Education, training, and/or knowledge of the impact of trauma on individuals, children, and families, is desired.