Billing Representative

2 weeks ago

Tampa, United States Pride Health Full time

Job Title: Billing Representative

Duration: 6-months with possibility of extension

Schedule: Monday – Friday // 8am-4:30pm

Location: Hybrid - Tampa, FL

The Billing Representative is responsible for performing medical billing functions and providing administrative support to the Billing and Collections department by managing the preparation of invoices and complete reconciliation of billing with accounts receivables. It may also include quality assurance and audit of billing activities.

ESSENTIAL FUNCTIONS:

  • Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with every internal and external customer.
  • Represents the Company in a professional manner, following all Company policies and procedures.
  • Uses, protects, and discloses patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
  • Ability to establish and maintain effective and positive working relationships with staff and management.
  • Ensures the timely submission of primary and secondary claims.
  • Maintains current working knowledge of CPT and ICD 10 codes, required modifiers and encounter data.
  • Performs electronic claims submission.
  • Notifies management of issues arising from erroneous codes, missing information, and error/edit messages.
  • Analyze relevant information to determine potential reasons for billing discrepancies and changes.
  • Seek assistance from internal partners (e.g., Coding; Credentialing; Clinics; Contracting) and/or external stakeholders (e.g., individual customers/payers; brokers) to resolve billing issues.
  • Reviews insurance claim forms for accuracy and completeness. Makes necessary corrections.
  • Demonstrates and applies knowledge of Medicare and Medicaid guidelines in reviewing claims to ensure appropriate use of modifiers and CPT/ICD 10 codes.
  • Review medical documentation to confirm appropriateness of codes when necessary.
  • Corrects claims appearing on Edit Reports.
  • Communicates system and claim formatting issues to the IT department and Billing Manager.
  • Serves as a resource to staff on general billing guidelines.
  • Demonstrate understanding of business partners' operations to identify appropriate resources for support and information.
  • Perform quality checks on data entries prior to submitting information to internal and/or external customers/payers/clients.
  • Inform customers/payers of billing problem/issue findings and resolution as appropriate.
  • Contact external customers/payers to keep them informed of outstanding balances and required payment, as appropriate.
  • Demonstrate and maintain understanding of state and federal regulatory requirements as they apply to billing operations (e.g., health-care reform; state surcharges; CMS)
  • May conduct training (e.g., on-line demonstration; knowledge base; invoice inquiry) to co-workers (e.g., new staff members, collection/cash posting teams) on how to access, review, and/or submit claims for payments.
  • Must be dependable and well organized.
  • Performs additional duties as assigned.


EDUCATION:

  • High school diploma, G.E.D. or equivalent
  • Some college education preferred.

MUST HAVE REQUIREMENTS:

  • 1+ year of related job experience.
  • CMC, CPC-A Certification
  • CPT/ICD 10 codes experience.
  • Microsoft Office skills
  • Working knowledge of business billing office duties.
  • Working knowledge of Medicare, Medicaid, and Managed care.

PREFERRED REQUIREMENTS:

  • CPC Certification
  • Previous coding experience.
  • HMO/managed care, Medicare experience.
  • Previous Allscripts, eCW, Athena, and/or RCX system experience.
  • PCP and Hospitalist billing and coding experience.
  • Bilingual preferred

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