(3) Sr. Medical Billers (245348)
San Diego, CA

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A local hospital seeks 3 Senior Billers for a 3+ month assignment at their location in San Diego :

  • Under the general supervision of the Billing Supervisor, the incumbent will assume responsibility for the various clerical functions associated with billing and follow-up of insurance claims
  • The incumbent will work professionally and courteously with patients, doctors, Insurance companies and various departments in order to obtain payment resolution on claims
  • Submits claims to insurance companies in a timely and accurate manner, ensuring accuracy of ICD-9 codes, CPT codes, and modifiers
  • Responds to insurance requests and correspondence in a timely and professional fashion
  • Responds to patient inquiries and requests from management, co-workers and other department in a professional, courteous, timely and proactive manner to remedy concerns and facilitate the billing process
  • Appeals denied claims with concise, accurate and articulate information. Explores all options to secure payment when a denial is received
  • Monitors paid claims to ensure correct contract rate has been paid and appropriate contractual adjustments have been applied to the claim
  • Using departmental aging reports, ensures that follow up on all outstanding claims are performed within contractual guidelines
  • Assists with the training of Junior Billers and new employees
  • Moderate level decision-making is required for Senior Biller
  • The incumbent must review claim payments and determine if in accordance with contract
  • Must review denials and appeal as necessary
  • Will determine what appropriate approach and appeal process should be used to receive reimbursement for services rendered
  • Must determine if a modifier or authorization is necessary to receive reimbursement on each service
  • Once insurance payor has been determined & set up on each patient account, incumbent must ensure that appropriate reimbursement is issued through claims follow-up and appeals processes
  • No supervisory skills required in this position; However, the Senior Biller acts as a mentor to other Billers assisting with training and problem resolution
  • Ideally, Senior Billers would be poised to take on additional responsibility with the goal of professional career progression to a Billing Supervisor position.
  • Communicates regularly, usually via telephone and email, with doctors, patients, insurance companies, co-workers and management, in a professional, cooperative fashion to identify issues, solve problems and make appropriate decisions
  • Sufficient knowledge to research and navigate payer websites & manuals to provide revised guideline information, coding changes, and/or billing updates to Billing Supervisor
  • High School or equivalent required; Billing Certification from appropriate school preferred.
  • Minimum of 3 years Billing experience required and/or senior level billing knowledge
  • Proven knowledge of ICD-9 coding, CPT and modifier coding
  • Proven knowledge of Medi-Cal, CCS and 3 rd party payors with pediatric medical surgical sub-specialties
  • Proven knowledge of Billing Software Systems
  • Proven knowledge and technical skills to perform insurance follow-up with positive financial results to include accuracy, timeliness and attention to detail
  • Ability to maintain patient confidentiality
  • Ability to work effectively as a team member; demonstrating cooperation and mutual support of both co-workers and management understanding that all are working toward a common goal
  • Ability to understand and act upon verbal and written instructions, prioritize and complete multiple tasks
  • Ability to courteously, professionally and calmly provide service to both internal and external customers even in tense situations
  • Ability to communicate with management any challenges experienced on the job regarding patient issues
  • Excellent written and verbal communication skills
  • Ability to communicate results to internal and external customers
  • Strong detail orientation
  • Ability to read and comprehend instructions, short correspondence and memos
  • Ability to apply common sense understanding and to deal with problems involving a few concrete variables in standardized situations
  • Routine office equipment including computer, printer, keyboard, copier, fax machine, calculator