Job Description

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work. (sm)

The Biller / Collector II is an Accounts Receivable function. To perform this job successfully, an individual should be able to perform each assigned essential duty satisfactorily.

This position is expected to have excellent reasoning skills based on knowledge of clinic operations as it pertains to billing claims to Insurance Health Plans, coding for medical diagnosis and procedural coding. Individual must be familiar with the conventions and instructions provided within the ICD disease classifications and CPT coding guidelines. Should be able to reason through insurance claims differences as defined by benefit and plan differences.

This position is responsible for resolution of A / R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including local, state and federal regulations regarding billing and collection practices are followed, as well as with established internal policy and procedure.

Additionally, this position may be responsible for any or all of the following: acting as a resource to other staff and clinics, timely billing or filing of claims for services rendered at the clinics, reviewing claims that are rejected / denied / not paid for errors or incorrect filing with the Carriers and Medicare, billing patients and collecting for fees deemed to be the patient's responsibility, billing secondary insurance, data entry of encounter data (or fee tickets) from the Clinics, and Evaluation and Management Documentation Guidelines.

Primary Responsibilities:

* Review medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filed
* Verifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation (Biller)
* Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information
* Responsible for working EDI claim rejections in a timely manner
* Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, Medicare, or patients. Able to apply correctly to claims / fee billed (Collector)
* Processes incoming EOBs to ensure timely insurance filing or patient billing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance
* Responsible for processing payments, adjustments and denials according to established guidelines (Payment Poster)
* Responsible for reviewing insurance payer reimbursements for correct contractual allowable amounts
* Responsible for reporting payer payment and denial trends in a timely fashion
* Responsible for reconciling transactions to ensure that payments are balanced
* Responsible for reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and procedures
* Responsible for keeping current with changes in their respective payer's policies and procedures
* Communicates with the Clinics to provide or obtain corrected or additional data
* Able to prepare documents for training or for establishing procedures for clinics
* Identifies problems and root cause of problems related to billing and collections
* Assist with training materials and training staff members
* Responsible for identifying problems / trends in medical documentation and reporting them in a timely fashion
* Answers patient and customer questions regarding billing and statements
* Prepare claims for encounters with complex progress note issues
* Participates with special assigned projects
* Performs all other duties as assigned
* The pace is fast and you'll need to be comfortable managing multiple priorities. You may be required to work in multiple locations, so scheduling flexibility is essential. You must also be able to respond calmly and effectively in emergency situations.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

* High school diploma or GED equivalent
* 4+ years of relevant medical experience/billing, coding or collections
* Strong attention to detail and professional customer service skills
* Proficiency with Microsoft Office applications
* You will be asked to perform this role in an office setting or other company location
* Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

* Medical terminology and ICD / CPT coding
* Technical skills in the areas of EDI, systems analysis and process flows
* 2+ years of related billing and / or collection experience
* Coding certification
* 50 wpm typing skill
* Knowledge of submission and resubmission of medical claims
* Knowledge of government and commercial policies and procedures
* Knowledge of ICD, CPT codes and HCPCS coding
* Knowledge of HIPPA compliance rules and regulations
* Skill in the operation of billing software and office equipment
* Skill in using Microsoft Office (Outlook, Excel, Word)
* Skill in processing claims efficiently and on a timely basis
* Solid customer service skills and excellent interpersonal skills
* Attention to detail

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Medical Biller, San Antonio, TX, Texas