Compliance Biller

The Compliance Biller is responsible to ensure claims are compliant with federal and state regulations, and Hospital and payer policies. This includes working late charges, combining accounts and file corrected claims. Responsible for overseeing all of the audits that come into the department. Work Esolutions denial reports and Cirus edits. Works closely with other departments to ensure proper billing. Assigned special compliant projects as needed.

• Education

High School Diploma - Preferred

• Experience

5-7 Years Hospital Patient Accounts - Required

• Experience with medical coding, medical terminology and CMS rules and guidelines - Required
• License & Certification

None Required

• Core Job Functions

Reviews multiple reports daily and accurately transfers charges and / or combines accounts as needed. Analyzes claims for compliance and accuracy and rebills and / or files adjusted claims when necessary.

• Reviews the report daily. Accurately files adjusted claims where appropriate. Accurately makes adjustments when appropriate.
• Completes independent audits to ensure billing accuracy and compliance with Health System policies, third party payer contracts and government regulations. Identifies, develops, and documents audit findings and recommendations. Ensures proper and complete documentation to support all audits and reviews.
• Submits assigned claims through Meditech and Billing Clearinghouse and provides confirmation reports to the manager. Reviews the Accounts Receivable Aging Report and works outstanding claims, oldest to newest, making calls to appropriate payor to determine claim status. Works with payor on resolving claim disputes, submits requested paperwork, and notifies Appeals Group for all denials.
• Accurately reviews and processes Medicare Returned to Provider (RTP) edits via vendor software daily. Accurately reviews and processes assigned Cirius and Meditech claim edits / denials daily. Analyzes RTP, claim edit and claim denial reports and develops action plans to improve efficiency as necessary.