ESSENTIAL FUNCTIONS:
• Handles Third party payer claims according to contract terms.
• Runs assigned daily billing reports to determine account needs and updates files with
current billing information
• Reviews and confirms that appropriate billing documentation has been obtained.
• Maintains knowledge of all insurance guidelines and applies that knowledge to billing as
required by individual contracts
• Identifies, monitors, and corrects electronic and paper claims to avoid delay in
processing.
• Check all claims were loaded and file was received.
• Verifies patient eligibility, authorizations and demographic information to ensure
accuracy of imported/keyed data.
• Ensures that all secondary billing is completed and billed to respective payor.
• Works unbilled revenue reports to verify pending claims and bring them to closure.
• Posting of all Electronic and paper EOB’s.
• Reconciles open accounts to establish patient responsibility, and accuracy of processed
insurance claims through resolution.
• Scanning and filing of all EOB’s and Authorizations.
• Performs related duties as required or as assigned by Supervisor.
QUALIFICATIONS/COMPETENCIES:
• Knowledge of payer website portals, clearing house portals, including FISS and MMIS.
• Knowledge of Medicare, Medicaid, Managed Care and Commercial insurance guidelines
and programs.
EDUCATION, LICENSURE, AND EXPERIENCE:
• Degree required or equivalent Behavioral Health and/or Hospital billing experience
required
• 5 years Medicare and other payor Billing/Collections experience preferred
• Experience with Billing Compliance guidelines
• Experience in Microsoft Office and other computer software products
• Sufficient typing and computer skills
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