Medical Biller x 2

JOB TITLE: Billing Representative II 
POSITION REPORTS TO: Billing Manager

GENERAL SUMMARY:
The Billing Representative I is responsible for the billing, payment posting, follow-up of unpaid claims, and appeals.

ESSENTIAL JOB FUNCTIONS:

• Performs back-end revenue cycle processes including billing, posting of payments, and follow up on pending claims or denied in conjunction with the Billing Coordinator
• Edits claims, payer rejections and clean claim submission on a daily basis.
• Monitors payer trends based on rejections and non-payment. Works claim follow up and claims denials to ensure maximum reimbursement for services provided.
• Posts charges and completion of claims to payers in a timely fashion.
• Responsible for submitting appeals according to payor requirements
• Performs insurance verifications to confirm member eligibility
• Responds to account inquiries submitted by the Customer Service Department
• Conducts claim and eligibility inquiries through Connex and Medi System for government plans
• Assists with claim resolution according to specialty payor requirements
• Provides documentation and verbiage for claim denials to ensure a proper appeal submission
• Provides quality service by enforcing quality and customer service standards
• Demonstrates and supports PediaTrust Core Values

ADDITIONAL JOB FUNCTIONS

• Other duties as assigned.

MINIMUM QUALIFICATIONS:
To perform this position successfully, an individual must be able to perform each job duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Required Education, Knowledge, Skills & Abilities:

• Minimum of High School Diploma required
• Ability to work independently and collaboratively within a team environment
• Ability to multi-task and meet deadlines
• Excellent problem-solving skills
• Understanding of payer policies in relation to billing
• Knowledge of Epic, eCW and/or other EHR systems preferred
• Strong knowledge and level of comfort with Microsoft Word and Excel strongly preferred
• Some knowledge of CPT and ICD-10 diagnosis coding preferred
• Strong written and verbal communication skills and high level of organizational skills required

Required Length & Type of Experience:

• Minimum of 2 years of medical billing experience required
• Minimum of 2 years multi-specialty experience required
• Minimum of 2 years government plans, such as Medicare and Medicaid, experience required
• Minimum of 2 years provider appeal experience

Required Certification, Licenses, Registration:
N/A

PHYSICAL/ENVIRONMENTAL DEMANDS:
The characteristics listed below are representative of the physical and environmental demands required by an individual to successfully perform the essential duties of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

• Some occasional travel between offices in the Chicagoland area may be required.
• Sitting
• Standing
• Walking
• Typing
• Computer work
• Telephone work

CORE VALUE

Trust. We are committed to integrity without compromise

• Be gently honest with all your customers – coworkers, patients, physicians, management
• Provide realistic expectations
• Keep your word, your commitments
• Protect the privacy of patients, parents and coworker

Partnership. We work as a team toward our shared purpose

• Demonstrate commitment to the partnership and its shared purpose
• Collaborate with your coworkers and other customers; offer to help
• Communicate information fully
• Maintain a positive outlook
• In conflict, work toward the goal of resolution rather than winnin

Excellence. We strive to exceed expectations in everything we do

• Strive to continually meet PCMH standards
• Consistently go the extra mile
• Take action to fix problems and to prevent repeat problems
• Consistently speak and behave in a friendly, helpful manner to all customers

Compassion. We are dedicated to serving others and fostering healthy relationships.

• Listen
• Acknowledge and demonstrate sensitivity to the feelings and needs of others
• When someone is upset, put yourself in their shoes and give the benefit of the doubt when you can

Respect. We treat all with dignity and embrace diversity

• Listen and pay attention when others are speaking
• Be polite
• Take action to protect another’s dignity
• Demonstrate openness to another’s point of view

As a PediaTrust team member, I am responsible for modeling the core values of PediaTrust.

NOTE: The above stated duties are intended to outline those functions typically performed by individuals assigned to this classification. This description of duties is not intended to be all-inclusive or to limit the discretionary authority of supervisors to assign other tasks of similar nature or level of responsibility.