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Medical Biller
3 months ago
Responsibilities of Commercial Health Biller:
- Initiate appropriate electronic billings to commercial insurance, Medicare Advantage and MassHealth MCOs per coverage and limitations.
- Responsible for claim follow up, Zero pays and the health bucket.
- Work with various staff to investigate and correct problems according to established procedures.
- Work with commercial insurance companies, MCOs and Medicare Advantage plans to identify status of accounts and obtain rapid resolution.
- Resolve all denials and initiate appropriate appeals
- Research customer complaints regarding accounts.
- Access online EOBs and accurately research claims.
- Use various systems to communicate, track, present and share information.
Qualifications of Commercial Health Biller:
- Minimum of one year of experience as a patient account representative in a hospital or medical office setting.
- Excellent interpersonal skills and strong team player.
- Knowledge of commercial payers (BCBS, Tufts, HPHC) billing requirements
- Knowledge of MCOs billing requirements
- Experience using Waystar or related clearinghouse software a big plus
- Must understand various payor EOBs.
- Extensive track record of insurance company phone interactions to resolve billing and/or EOB questions.
- Thorough experience with multiple payor online system access
Moderate to expert computer skills.