IMCS Group
Job Title: Medical Biller/Collector III
Duration: 06 months Contract
Location: 4900 Rivergrade Road, Irwindale, CA 91706
Shift Type: 8am – 5pm M-F
pay range: $20 - 28/hr. (Pay range depending on the experience)
Responsibilities: • Generates monthly work files for staff based on monthly review of volume and internal policies and procedures or as needed. • Facilitates communications with payers to address outstanding claims, denials, or remits to resolve payment variances, and works to develop and maintain positive relationships with payers. • Initiates communications with providers to address any outstanding issues impacting revenue; makes recommendations for resolving and/or improving the flow of data and maximizing charge capture. • Reviews denial reason codes and underpayments to identify root causes; works with payer contracting and other areas of the revenue cycle if necessary to resolve issues. • Analyzes data to track and identify trends and provides team with updates and ideas for improvement. • Assists staff in identifying high-risk accounts and prioritizing resolution efforts; Ensures staff is researching high dollar accounts, high volume denials, credits, adjustments, and undistributed balances, etc. in adherence to internal policies and procedures. • Maintains superior understanding of CPT/HCPCS codes, ICD-10 codes, CMS 1500 form guidelines, eligibility and coverage requirements, remit and remark codes, payor/plan codes, claims management, third-party payer guidelines, state and federal regulations, claims clearinghouse workflow, and all other pertinent functions of the job. • Has thorough knowledge of managed care contracts, DOFRs, reimbursement rates, and other billing requirements mandated by said agreements with payors. • Collaborates with other departments to identify best-practice strategies, align goals, and improve collections. • Ensures staff is working work queues in adherence to internal policies and procedures. • Ensures that all necessary documentation and information is correct according to divisional policies and procedures for approval of charge corrections and refunds.
Skills: • Demonstrated knowledge of claims review and analysis; ICD-10, CPT, and HCPCS coding; and medical • Terminology • Effective communication, leadership, organizational, and problem-solving skills • Ability to manage multiple tasks and projects simultaneously • Ability to analyze data, identify improvement, and implement change • Demonstrated written and verbal communication skills. Ability to plan and carry out responsibilities with minor supervision • Excellent verbal and written communication skills • Excellent interpersonal skills with customer service focus
Experience • Minimum of 2 - 7 years of experience performing medical billing functions. Minimum experience includes corresponding with insurance companies in resolving patient accounts. • Extensive knowledge of insurance carrier procedures, including Medicare, Medi-Cal and other third-party payors. Experience with reading Explanations of Benefits (EOB) statements. • Proven ability to handle multiple conflicting tasks
Education/Experience: High school diploma or equivalent
Responsibilities: • Generates monthly work files for staff based on monthly review of volume and internal policies and procedures or as needed. • Facilitates communications with payers to address outstanding claims, denials, or remits to resolve payment variances, and works to develop and maintain positive relationships with payers. • Initiates communications with providers to address any outstanding issues impacting revenue; makes recommendations for resolving and/or improving the flow of data and maximizing charge capture. • Reviews denial reason codes and underpayments to identify root causes; works with payer contracting and other areas of the revenue cycle if necessary to resolve issues. • Analyzes data to track and identify trends and provides team with updates and ideas for improvement. • Assists staff in identifying high-risk accounts and prioritizing resolution efforts; Ensures staff is researching high dollar accounts, high volume denials, credits, adjustments, and undistributed balances, etc. in adherence to internal policies and procedures. • Maintains superior understanding of CPT/HCPCS codes, ICD-10 codes, CMS 1500 form guidelines, eligibility and coverage requirements, remit and remark codes, payor/plan codes, claims management, third-party payer guidelines, state and federal regulations, claims clearinghouse workflow, and all other pertinent functions of the job. • Has thorough knowledge of managed care contracts, DOFRs, reimbursement rates, and other billing requirements mandated by said agreements with payors. • Collaborates with other departments to identify best-practice strategies, align goals, and improve collections. • Ensures staff is working work queues in adherence to internal policies and procedures. • Ensures that all necessary documentation and information is correct according to divisional policies and procedures for approval of charge corrections and refunds.
Skills: • Demonstrated knowledge of claims review and analysis; ICD-10, CPT, and HCPCS coding; and medical • Terminology • Effective communication, leadership, organizational, and problem-solving skills • Ability to manage multiple tasks and projects simultaneously • Ability to analyze data, identify improvement, and implement change • Demonstrated written and verbal communication skills. Ability to plan and carry out responsibilities with minor supervision • Excellent verbal and written communication skills • Excellent interpersonal skills with customer service focus
Experience • Minimum of 2 - 7 years of experience performing medical billing functions. Minimum experience includes corresponding with insurance companies in resolving patient accounts. • Extensive knowledge of insurance carrier procedures, including Medicare, Medi-Cal and other third-party payors. Experience with reading Explanations of Benefits (EOB) statements. • Proven ability to handle multiple conflicting tasks
Education/Experience: High school diploma or equivalent