Biller Service Representative

Biller Service Representative
Business Office

The Biller Service Representative will:
  • Ensure account accuracy.
  • Review daily claims to ensure submissions are clean and timely.
  • Monitor charges/modifiers/CPT-4s/HCPCS/payments/DRGs/ICD-10 coding.
  • Review outstanding accounts using ATB/queues/payments reports/halt report/electronic billing edits/credit balances.
  • Submit timely and accurate adjustments/notes/patient balance transfers and medical record requests.
  • Work with management team and notifying of notifying of issues that arise with payors/departments/etc
  • Resolve account issues and problem solving independently whenever possible.
  • Use technology provided (including hospital information system, contract management system, electronic billing system, payer websites and document imaging system.)
  • Manage denials and appealing administrative claims.
  • Understand denials and how they should be handled.
  • Send clinical denials and downgraded claims to appropriate parties to ensure timely appeal.
  • Ensure claims denied at time of billing are distributed to appropriate parties for review.
  • Update and correct accounts with assistance of originating departments (charges/authorizations/insurance issues).
  • Follow departmental and hospital policy and procedure (this includes HIPAA guidelines and Federal guidelines).
  • Understand payor contracts and billing guidelines; revenue codes and payor specific requirements; and payor/plan codes.

  • Requires one (1)or more years experience as a Medical Insurance Biller or related responsibilities and Hospital Billing strongly preferred.
  • Proficient in Microsoft Word and Microsoft Excel.
  • Requires high level of interpersonal skills necessary to lead others and to work effectively with Patient Accounts Personnel as well as outside agencies.
  • Must possess a comprehensive knowledge of Collection, A/R follow-up and Billing. Knowledge of third-party payers, State and Federal Agencies (constantly changing) with regards to Patient Accounting.
  • Requires the ability to consistently meet deadlines, to concentrate and pay attention to details 75% of work time.

Grade 114