Brooklyn Senior Biller

Job Description

Job Description

Description :

The Senior Billing Representative has at least three years’ experience and a demonstrated record of high-quality and high-volume billing. This incumbent is responsible for accurate coding and follow-up on insurance claims and resolve unpaid accounts in a timely and efficient manner while maintaining the minimum production standards set by the Billing Manager.

Requirements : Billing Job Duties :

• Process claims within an appropriate timeframe (e.g. claim status check, appeals of denied claims).
• Recode insurance claims into the Accounts Receivable Billing System as necessary.
• Update appropriate modifiers based on origin and destination of the trip and change insurance claims as necessary.
• Create narrative in the Accounts Receivable Billing System to document status of trip for use in claim appeals.
• Ensure charges are billable to a particular insurance based on the payer’s criteria (e.g. prior authorization) as needed.
• Resolve payment issues with carrier (e.g. denials partial payments, etc.).
• Refile and appeal claims as necessary.
• Process incoming correspondence, including signatures letters, denials, and additional information necessary to release the claim.
• Review clearinghouse transmission listings and carrier acknowledgment reports to make appropriate corrections as required.
• Determine the appropriate level of service to be billed based on supporting documentation on the PCR and or in the CAD notes, including but not limited to, designating Advanced Life Support (ALS), Basic Life Support (BLS), Wheelchair, Specialty Care Transport (SCT), or Critical Care Transport (CCT).
• Assign appropriate condition code / ICD-10 codes into the Accounts Receivable Billing System.
• Accept incoming calls from carriers, providers, and patients.
• Ensure all Medicare billing requirements are met. (Certificates of Medical Necessity, Signatures etc.).
• Identify patterns of concern in medical documentation that may affect payment of claim. (Medical Necessity calls to providers, Clinical Documentation Improvement forms for crew members).
• Complete Ambulance Certification for all Medicare claims.
• Verify eligibility of benefits via internet and or telephone.
• Escalate the appeal process as needed.
• Proactively update skills and knowledge on billing regulations and practices
• Responsible for assisting with training peers to ensure understanding of the current processes and billing practices.
• Demonstrate billing subject matter knowledge at an expert level to encourage and assist in development of peers.
• Accept and complete interim assignments in a timely manner.
• Manage own time and work assignments effectively.
• Seek advice / feedback in terms of priorities or issues when necessary.
• Perform other duties as assigned and required.

Interpersonal :

Knowledge :

Abilities :

Minimum Requirements :

Physical Demands

While performing the duties of this job, employees are regularly required to sit, walk and stand; talk or hear, both in person and by telephone; use hands repetitively to finger, handle, feel or operate standard office equipment; reach with hands and arms; and lift up to 15 pounds.

Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus.

Mental Demands

While performing the duties of this job, employees are regularly required to use written and oral communication skills; read and interpret data, information and documents; analyze and solve non-routine and complex office administrative problems; use math and mathematical reasoning; observe and interpret situations; learn and apply new information or skills; perform highly detailed work on multiple, concurrent tasks; work under intensive deadlines with frequent interruptions; and interact with healthcare professionals, facility representatives, staff, customers, the public and others encountered in the course of work, some of whom may be dissatisfied individuals.

Working Environment :

Equipment Used :

This document in no way constitutes a contract of employment. This description is not intended to be an exhaustive listing of all skills, duties, or responsibilities associated with the job. Management reserves the right to revise the job, or to require that other or different tasks be performed, should circumstances change (e.g. changes in personnel, workload, or technological developments).