Biller​/Non-Government

Job Summary

Under general supervision, the Biller Non-Government is responsible for managing assigned patient accounts from the point of pre-billing through final billing. This includes ensuring the review of accounts to ensure data is complete and accurate for billing, according to billing and payor specific guidelines and requirements.

The Biller/Collector Government serves as a key liaison between the Business Office and both internal departments and external customers, maintaining a high level of professionalism and customer service.

• Minimum of 2 (two) years of demonstrated hospital Managed Care, Commercial, Workers Comp., Government payer billing experience required.
• In-depth knowledge of medical terminology, Revenue Codes, UB04, CPT, HCPC, ICD-10 Diagnosis and Procedure codes as required for billing.
• Familiarity of, but not limited to MS DRG, APR DRG, Per Diem, Administrative days, Stop loss, Contract billing guidelines.
• Familiarity with but not limited to Health Networks, IPAs, HMOs, PPOs, PCPs Workers Comp.
• Strong analytical skills and proven proficiency in Microsoft Office, Word, especially Excel and spreadsheets.
• Understanding of billing guidelines, techniques and laws.
• Excellent verbal and written communication skills.
• Exceptional organizational skills, with the ability to meet deadlines, work independently or as part of a team, and prioritize tasks effectively.
• Familiarity of Medicare’s Common Working File (CWF), Medi-Cal website, Medicare intermediary website, Internet, payer websites and electronic billing systems.

• High school diploma or equivalent education required.

• Must successfully complete and maintain LA City Fire Card certification at the time of hire or within the first 30 days of employment.

• All required licensures, certifications, mandatory education; along with annual occupational health screenings must be completed prior to the expiration date or by the end of the month in which they are due. Reference the
  
  Educational Requirements:
  
  Must Haves, Mandatory and Unit Based policy (in electronic policy management system) for the specific requirements for this position.

• Manage assigned accounts from the point of pre-billing until billed.
• Maintain thorough knowledge of Managed Care, Commercial, Workers Comp., Government billing guidelines, updates and changes such as, but not limited to, cross over billing, eligibility, authorizations.
• Preview pre-bills through the EMR system and DNFB to ensure accuracy and completeness.
• Submit claims timely electronically or hardcopy using electronic billing system vendors and payer requirements.
• Attend billing system vendors and payer training webinars.
• Resolve billing rejections accordingly in payer or billing system vendors’ system.
• Comprehend and follow internal and external policies and procedures.
• Present a professional image of the Business Office at all times.
• Diligently follow up on claims rejections and document accounts to ensure timely resolution.
• Submit documentation to Managed Care, Commercial, Workers Comp., Government payers as needed, but not limited to initial bills, corrected bills, rebills, medical records, EOBs, etc. according to internal and external policies and procedures.
• Initiate and maintain verbal and written communication with billing system vendors to resolve reimbursement discrepancies of outstanding rejected claims.
• Communicate, verbally and in writing, with billing system vendors, providers, patients, and internal departments to gather necessary information to resolve rejected claim issues.
• Accurately maintain individual billing procedure manuals for but not limited to Managed Care, Commercial, Workers Comp., Government payers and vendors.
• Identify, report and participate in any workflow, billing issues with supervisor.
• Interpret Managed Care, Commercial, Workers Comp., Government payer contracts related to, but not limited to billing requirements.
• Attend and participate in work groups, and team meetings as required.
• Participate in payer conference call discussions and provide payers and billing system vendors with necessary information…