Lead Biller

**TITLE**: LEAD BILLER
**DEPARTMENT**: FISCAL
**SUPERVISOR**: FINANCIAL SERVICES MANAGER
**CLASSIFICATION**: FULL TIME NON-EXEMPT

***:
Processes Medical billing in accordance with Fiscal Policies and Procedures. Maintains all billing records and computerized billing software. Biller to optimize reimbursements from third party payers. Ensures that the goals and objectives of the department are consistent with LCTHC policy and any governmental regulations.

**ESSENTIAL JOB FUNCTIONS**:

- Responsible for completing insurance claims for designated third party payers in a timely manner,
- Responsible for correcting all errors in RPMS for orphan test, missing information, etc. prior to submission of claims to insurer.
- Responsible for assuring that all coding (CPT, ICD-9, HCPCS, etc.) are applied and billed in the correct manner to the insurance company.
- Validates compatibility and medical necessity between CPT and ICD-9 coding.
- Inputs computer information for electronic processing and edits of eligible claims (Medicare and Medicaid) and corrects any electronic rejections immediately through infinedi, LCTHC electronic clearing house.
- Prints, sorts and mails manual claim forms (private and dental) to insurer.
- Reviews insurance return mail and determines reasons for return and follows up the claim.
- Shares information on any significant changes in coding, benefits, coding errors, etc.
- Keeps in close contact with the insurer to better understand their specific billing rules and regulations.
- Researches all information related to a denied claim and processes a corrected bill in a timely manner, one that is established by the facility.
- Bills the appropriate primary insurer and follows up that secondary insurance is paid either manually or electronically.
- Always respects the confidentiality of medical / charge information in performing job duties.
- Post payment on a timely basis, within month received.
- Generates monthly reports as requested by Financial Services Manager and Chief Fiscal Officer
- Monitors accounts receivable aging for past due accounts and takes appropriate action in accordance with Fiscal Policies.
- Provide work coordination, training and direction for projects assigned to the billing assistant and the medical and dental billing specialists.
- Works closely with other departments as assigned to develop and coordinate processes that optimize service reimbursement.
- Completes pharmacy billing functions while ensuring that pharmacy revenue and collections are optimized.
- Provides information and reports to the Fiscal Officer for use in determining an allowance for doubtful/uncollectible accounts.
- Completes other billing and financial services functions as assigned.
- Establish and maintain a productive working relationship with the Medical, Dental and HIM department staff to enhance department operations.
- As assigned, acts as a resource to other departments on billing and other financial service matters.
- Other duties as may be assigned

**EDUCATION, EXPERIENCE, CERTIFICATIONS AND LICENSES**:

- CA driver’s license
- High School Graduate or GED
- Type 45 WPM
- Must possess math skills, telephone skills, medical terminology and computer knowledge
- Two years experience as a billing clerk
- Previous experience with billing and accounts receivable
- Knowledge of medical / dental terminology
- Experience with training staff and good communication skills with customers
- Previous computer experience is essential
- Ability to effectively communicate and work well with others

**All LCTHC employees are expected to**:

- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the LCTHC policies and procedures as they may from time to time be updated.

**PHYSICAL DEMANDS**:
The physical demands described here are representative of those that must be met by an
**INDIAN PREFERENCE**: Preference may be given to qualified Native American Indians according to the Indian Preference Hiring Act, CFR 25 USC 472. Other than Indian Preference, Lake County Tribal Health Consortium, Inc. adheres to all provisions of the Equal Employment Opportunities Act.
**NOTICE OF DRUG-FREE WORKPLACE ACT REQUIREMENT**: LCTHC is committed to maintaining a drug free and alcohol free workplace. LCTHC believes that a healthy, productive workforce free from the effects of drugs is very important to all employees and patients. Substance abuse is incompatible with the health, safety, efficiency and success of LCTHC. Employees who are under the influence compromise LCTHC’S interests, endanger their own and the health and safety of others and can cause a number of other work-related problems. As a condition of employment, each applicant receiving a job offer from LCTHC must take and pass a required drug screen test.

**HIPAA Health Insurance Portability and Accountability**:
This act was enacted to deal with three