Medical Biller

Summary: The Medical Biller will perform a variety of accounting duties involved in submitting compliant ambulance claims to various insurance providers. The Medical Biller will be contacting patients, insurance carriers, hospitals, facilities, and others to collect information to receive payments for services provided. The individual will work directly under the supervision of the Director of Billing and Billing Supervisor.

Essential Responsibilities include the following. Other duties may be assigned.

· A knowledge of Medicare, Medicaid, and private insurance

· Verifying patient’s insurance coverage

· Answering patients billing questions

· Working directly with insurance companies to get claims processed and paid

· Appealing unpaid and denied claims

· Posting payments to patient accounts

· Handling collections on unpaid accounts

· Follow up on aging reports to retrieve payment

· Medical, insurance and healthcare terminology

· Ability to recognize vital signs that are not within normal limit and code them to the appropriate diagnosis

· Knowledge of E.O.B.’s (Explanation of Benefits)

· Process E.O.B.’s

· Submit eTAR’S (Electronic Treatment Authorization Requests) to Medi-Cal

· Process approvals for eTAR’s

· Process facility monthly invoices

· Collection calls to patients on unpaid claims

· Properly code ambulance claims to submit to insurance companies

· Process/ mail out claims on CMS 1500 forms

· Audits transactions and records for accuracy and to ensure compliance to medical billing guidelines

· Other projects and assignments as assigned

Competencies: To perform the job successfully, an individual should demonstrate the following:

· Job Knowledge / Technical Skills – Thoroughly understands all aspects of the job; possesses practical hands-on experience. Drive to continuously build knowledge base and improve professional skills, especially in pay and scheduling practices. Thoroughly understands all aspects of company’s payroll and scheduling policy and procedures.

· Employee Communication - Manages difficult or emotional employee situations; Responds promptly to employee needs; Keeps confidential employee matters; Meets commitments.

· Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.

· Communication - Speaks and writes clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Writing is clear, informative and professional.

· Teamwork - The ability to work effectively with others, balancing the needs of the team and those of the individual; Gives and welcomes feedback.

· Administration and Organization Support - Follows policies and procedures; Processes paperwork accurately, timely and legibly; Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.

· Productivity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. Can be relied upon to meet schedules, deadlines and productivity standards; completes tasks on time or notifies appropriate person with and alternate plan; Ability to prioritize workload, attain needed resources and execute a plan that optimized results.

· Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.

· Attendance and Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.

· Safety and Security - Daily actions demonstrate our standard for a safe and secure workplace.

· Planning Organization- Ability to prioritize workload, attain needed resources and execute a plan that optimized results.

· Professionalism- Approaches others in a tactful manner; reacts well under pressure; treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions; follows through on commitments.

· Dependability- Can be relied upon to meet schedules, deadlines and productivity standards; completes tasks on time or notifies appropriate person with and alternate plan.

· Appearance and Grooming- Practices an appropriate grooming, hygiene and attire selection.

· Innovation- Displays original thinking and creativity/ meets challenges with resourcefulness; generates suggestions for improving work; develops innovative approaches and ideas; presents ideas and information in a manner that gets others’ attention.

· Problem Solving/Judgement- Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions and assess consequences; works well in group problem solving situations; uses reason even when dealing with emotional topics.

· Initiative- Volunteers readily; undertakes self-development activities; seeks increased responsibilities; takes independent actions and calculated risks; looks for and takes advantage of opportunities; asks for and offers help when needed; Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence.

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

· Education and/or Experience: Either a high school diploma or a GED as evidence of a high school education. Certified Medical Biller and Coder (preferred, but not required)

· Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

· Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

· Reasoning Ability: Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

· Computer Skills: Ability to type 45 WPM and be proficient with 10-key. Demonstrate proficiency with Microsoft Work, Excel, Power Point and Outlook. Become proficient with Traumasoft- Billing CAD.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is:

Standing and Sitting: Specific demands for standing and sitting on this job:

· Frequently required to stand;

· Frequently required to sit

Walking and Reaching: Specific demands for walking and reaching on this job:

· Frequently required to walk and reach with hands and arms

Climb, Balance, Crawl: Specific demands for this job:

· The employee is occasionally required to climb or balance and stoop, kneel, crouch, squat, or crawl.

Dexterity and Sense of Touch: Specific demands for sense of touch and dexterity on this job:

· Frequently required to use hand to finger movements, handle, or feel;

Lifting: Specific demands for lifting on this job:

· Regularly lift and/or move up to 25 pounds

Vision: Specific vision abilities required by this job:

· Close vision

· Distance Vision

· Color Vision

· Peripheral Vision

· Depth perception

· Ability to adjust focus

Verbal and Auditory Demands: Specific talking and hearing abilities required by this job:

· Must be able to talk and hear

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

· The noise level in the work environment is usually moderate.

Compliance: Will comply with all applicable laws pertaining to fraud and abuse as defined by the Office of Inspector General regarding kickbacks for the provision of utilizing medical transportation services. Will hold in confidence matters that are considered privileged information or trade secrets.

Conditions of Employment: This job has conditions of employment essential to the position. This list is not considered comprehensive and other conditions of employment are likely due to the nature of the position.

· Valid Driver's License

· Meets Company Insurance Carrier Standards for Insurability

· Approved background clearance from regulatory agencies (DOJ, LEIE, EMSA)

Job Type: Full-time

Pay: From $16.50 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Ability to commute/relocate:

• Sacramento, CA 95827: Reliably commute or planning to relocate before starting work (Preferred)

Experience:

• Medical billing: 1 year (Preferred)

Work Location: One location