GENERAL STATEMENT OF DUTIES:
The Patient Billing Representative works in direct support of one or more clinical programs, ensuring that patients and third parties are appropriately billed and fees collected for clinical services received. The Medical Billing Representative receives, prepares, processes, and maintains documents germane to billing while utilizing systems and processes established as operational best-practices.
ESSENTIAL FUNCTIONS:
- Prioritize daily work to ensure achievement of established productivity and A/R goals.
- Review and release claims to payers.
- Effectively manage claims follow-up, aging and denial work queues to ensure maximum reimbursement for services provided.
- Initiate and track appeals following appropriate payer guidelines.
- Identify issues impacting A/R and proactively communicate those issues to the Director, Revenue Cycle.
- Interprets government, commercial, WC, Auto and TPL remittance advices and makes appropriate corrections to unpaid claims for resubmission.
- Posts remittances, rejections and adjustments to patient accounts.
- Works with Patient Accounts Clerk regarding self-pay accounts.
- Communicates effectively with clinical staff and other staff members of the Business Services Department.
QUALIFICATIONS:
- Three years medical billing experience, preferably within a multispecialty practice setting
- Proficiency with electronic medical records (EMR), Epic experience a plus
- Medical Billing related credentials from a certifying institution preferred.
CMU is an AA/EO institution, providing equal opportunity to all persons, including minorities, females, veterans, and individuals with disabilities.
