Medical Biller

Frederick, MD
Sep 01, 2021
Sep 15, 2021
Administrative, Other
Full Time
Job Responsibilities:

• Gathers and submits the initial claims to the various payors, either electronically or directly to the funder, through the clearinghouse or on paper claim forms

• Verify accuracy of billing data and report to your manager for further instructions

• Posting of charges

• Collecting and analyzing claims

• Obtains authorizations for payment

• Processing denials

• Address patterns of underpayments and/or denials

• Appeals and follow-up with the different insurance carriers, including composing and submitting proper appeals accordingly

• Finding solutions, working assigned claims, identifying, and documenting problematic issues that prevent the successful and timely submission of accurate claims

• Analyzing claims; verify accuracy of billing data

• Reviews the EOBs and processes the rejections and denials in a timely manner

• Reviews, monitors, and evaluates third party reimbursement compliance and researches variances

• Reviews chart documentation under audit for accuracy and completeness prior to submitting records to insurance carriers


• Good understanding of benefits and eligibility rules for each payor

• Maintains up-to-date knowledge of coding including CPT, HCPCs and ICD-10

• Assists manager in performing special projects related to revenue enhancement and problem resolution

• Follows Newbridge/Privia policies and procedures related to billing and reimbursement activities under the direction of the revenue cycle manager

• Participates with collection operations to ensure consistent application, interpretation, and implementation of policies and procedures

• Maintains the strictest confidentiality regarding patients' accounts, in compliance with HIPAA and other privacy and security polices and regulations

• Perform a variety of duties related to Patient Account Billing for all entities including physician offices, ASC, anesthesia, etc.

• Works collaboratively within a team environment and provides back up and supports other department staff when needed

• Answer mail and telephone inquiries regarding procedures, next steps, problem resolution

• Provide/assist offices under the guidance of your manager according to directives related to improved customer service and patient follow-up, etc.

• Interact with Privia/Athena/Billing Office contacts as directed by your manager

Job Requirements:

• Occasional travel to all locations

• Keeps executive management advised of trends and issues

• Offers suggestions for resolution

• Participates in staff meetings to discuss new and modified procedures

• Must be well-organized, able to multi-task, detail oriented, accurate and able to complete projects and assignments in a timely manner

• Flexibility and ability to respond to changing priorities

• Computer proficiency Microsoft

• Proficiency in practice management software/billing applications; MicroMD, Athena, etc

• Ability of maintaining highly confidential information

• Experience and proficiency with medical office billing

• Knowledge of health insurance contracting principles, reimbursement, terms, and conditions required

• Ability to perform critical thinking with effective communication skills

• Ability to use data entry for patient information and scheduling

• Ability to use strong concentration skills

• Ability to rely on verbal memory and learning of new medical terminology

• Knowledge of medical insurance requirements

• Ability to read manuals, summaries, reports, and written communications


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Qualified candidates should send their resume AND call Sparks Group for additional details. Please note, resume must include a valid email address in order to be considered. We look forward to discussing your background, your current job search, and your potential career path with Sparks Group!

Sparks Group is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, pregnancy, citizenship, family status, genetic information, disability, or protect veteran status.

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