Medical Biller

Position Title: Medical Biller

Purpose of this position:
The purpose of this position is to organize and maintain all records related to medical billing in an effective, efficient and financially sound manner. To prepare and submit accurate statements of resident charges to appropriate payers.

Delegation of authority:
Authority is delegated to the individual in this position to:

1. Implement and maintain systems to collect, document, process and submit accurate, complete resident charges to appropriate payers.
2. Implement and maintain systems to establish a valid paper trail for all resident charges from the provision of goods and services to receipt of reimbursement.
3. Implement systems to ensure confidentiality of resident financial information.
4. Implement systems to ensure compliance with federal, state and local requirements for resident and facility financial records.
5. Implement systems to collect, process, organize, file and maintain all records related to reimbursement in a financially sound manner.

This position reports to: Administrator

1. Work cooperatively with facility staff.
2. Evaluate facility needs to submit accurate statements of resident charges to appropriate payers.
3. Implement and maintain an effective, organized, efficient system to submit accurate statements of resident charges to appropriate payers.
4. Prepare and submit accurate, complete statements of resident charges to appropriate payers.
5. Maintain accurate, neat, organized files of all data related to resident medical billing.
6. Keep informed on all federal, state and local requirements related to medical billing.
7. Issue resident notifications of medical billing as required.
8. Process correspondence related to reimbursement in a courteous, timely and accurate manner.
9. Verify accuracy of resident charges from all sources.
10. Collect and enter accurate clinical data for federal and state reimbursement.
11. Communicate and work cooperatively with residents, residents' representatives, fiscal intermediaries, carriers, accountants, HMOs, auditors, cost report preparers and private insurance companies.
12. Communicate and work cooperatively with facility vendors, suppliers, contractors and ancillary service personnel.
13. Justify Remittance Advice records.
14. Accurately track and collect reimbursement due from all payer sources.
15. Maintain accurate records on resident health benefits from all payer sources.
16. File inquiries, reconsiderations and appeals to the appropriate payer sources upon receipt of rejection of reimbursement for any reason.
17. Follow up on all account collection procedures.
18. Observe all facility safety policies and procedures.
19. Perform other related duties as directed by his/her supervisor.
20. Follow all infection control procedures.
21. Accept assigned duties in a cooperative manner.
22. Assume accountability for all data contained in the employee handbook.
23. Assume Quality Assurance duties as assigned.
24. Perform other related duties as directed by his/her supervisor.
25. Report for work in neat, clean attire and consistently present an appropriate professional appearance.
26. Report for work as scheduled and consistently demonstrate dependability and punctuality.
27. Consistently work cooperatively with residents, residents' representatives, facility staff, physicians, consultants and ancillary service providers.
28. Agree not to disclose assigned user ID and password for accessing resident/facility information. Promptly report suspected or known violations of such disclosure to the Administrator.
29. Agree not to disclose resident's protected health information and promptly report suspected or known violations of such disclosure to the Administrator.
30. Report any known or suspected unauthorized attempt to access facility's information system.
31. Report suspected or known incidents of fraud relative to false billings, cost reports, kickbacks, etc.
32. Take part in in-service education programs as assigned.
33. Report suspected resident abuse immediately to the Administrator.
34. Ensure that department computer workstations left unattended are properly logged off or the password protected screen saver activates within established facility policy guidelines.