Sr. Billing Rep - San Antonio, TX (14996963)
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)
The Biller/Collector II position is an Accounts Receivable function. To perform this job successfully, an individual should be able to perform each assigned essential duty satisfactorily.
This position is expected to have excellent reasoning skills based on knowledge of clinic operations as it pertains to billing claims to Insurance Health Plans, coding for medical diagnosis and procedural coding. Individual must be familiar with the conventions and instructions provided within the ICD disease classifications and CPT coding guidelines. Should also be able to reason through insurance claims differences as defined by benefit and plan differences.
This position is responsible for resolution of A/R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including, local, state, and federal regulations, regarding billing and collection practices are followed; as well as with established internal policy and procedure.
Additionally, this position may be responsible for any or all of the following acting as a resource to other staff and clinics: timely billing or filing of claims for services rendered at the clinics; reviewing claims that are rejected/denied/not paid for errors or incorrect filing with the Carriers and Medicare; billing patients and collecting for fees deemed to be the patient’s responsibility; billing secondary insurance; data entry of encounter data (or fee tickets) from the Clinics; and Evaluation and Management Documentation Guidelines.
- Review medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filed
- Verifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation
- Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information
- Responsible for working EDI claim rejections in a timely manner
- Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, Medicare, or patients. Able to apply correctly to claims/ fee billed.
- Processes incoming EOBs to ensure timely insurance filing or patient billing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance
- Responsible for processing payments, adjustments and denials according to established guidelines
- Responsible for reviewing insurance payer reimbursements for correct contractual allowable amounts
- Responsible for reporting payer payment and denial trends in a timely fashion
- Responsible for reconciling transactions to ensure that payments are balanced
- Responsible for reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and procedures
- Responsible for keeping current with changes in their respective payer’s policies and procedures
- Communicates with the Clinics to provide or obtain corrected or additional data
- Able to prepare documents for training or for establishing procedures for clinics
- Identifies problems and root cause of problems related to billing and collections
- Assist with training materials and training staff members
- Responsible for identifying problems/trends in medical documentation and reporting them in a timely fashion
- Answers patient and customer questions regarding billing and statements
- Prepare claims for encounters with complex progress note issues
- Participates with special assigned projects
- Performs all other related duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- Technical skills in the areas of EDI, systems analysis and process flows
- 2+ years of related billing and/or collection experience required
- Knowledge of submission and resubmission of medical claims.
- Knowledge of government and commercial policies and procedures.
- Knowledge of ICD, CPT codes and HCPCS coding.
- Knowledge of HIPAA compliance rules and regulations.
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
- Coding certification
- 50wpm typing skill
- Skill in the operation of billing software and office equipment.
- Skill in using Microsoft Office (Outlook, Excel, Word)
- Skill in processing claims efficiently and on a timely basis
- Solid customer service skills and excellent interpersonal skills
- Attention to detail
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
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Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
Job Keywords: Biller, Billing, San Antonio, TX