Medical Biller - Bainbridge Nursing & Rehabilitation Center

The HMO Biller is responsible for preparing, submitting, and managing insurance claims to HMOs, ensuring accurate and timely reimbursement for healthcare services. This role involves extensive interaction with insurance companies, healthcare providers, and patients to resolve billing issues and optimize revenue cycle processes.

Key Responsibilities:

• Claims Preparation and Submission:

  • Prepare and submit clean claims to HMOs, ensuring all necessary documentation is included.
  • Verify patient insurance coverage and eligibility before billing.
  • Utilize billing software to generate claims and track submissions.

• Accounts Receivable Management:

  • Monitor and follow up on unpaid or denied claims, working with HMOs to resolve issues.
  • Reconcile accounts and manage accounts receivable aging reports.
  • Post payments and adjustments to patient accounts accurately.

• Denials and Appeals:

  • Review and analyze denied claims, determining the cause of denial.
  • Prepare and submit appeal letters and supporting documentation to HMOs.
  • Track the status of appeals and work to resolve them promptly.

• Skills:

  • Strong understanding of medical terminology, CPT, ICD-10, and HCPCS coding.
  • Excellent organizational and time management skills.
  • Detail-oriented with a high level of accuracy.
  • Strong communication and interpersonal skills.
  • Proficiency in Microsoft Office Suite and billing software.

• Attributes:

  • Ability to work independently and as part of a team.
  • Problem-solving skills and the ability to handle complex billing issues.
  • Commitment to maintaining patient confidentiality and compliance with HIPAA regulations.

Summary:

The HMO Biller plays a critical role in the financial health of healthcare organizations by ensuring that claims are processed accurately and efficiently. This position requires a thorough understanding of HMO billing processes, strong attention to detail, and the ability to work collaboratively with various stakeholders to resolve billing issues.