Osceola Medical Center
Medical Biller - 1.0 FTE *Hybrid/Remote Opportunity*
Osceola Medical Center, Osceola, Wisconsin, United States, 54020
Summary:
The Medical Biller is responsible for preparing, reviewing, correcting, and updating insurance claims for submission to payers,
Typical Schedule:
Full Time, Monday through Friday, Days
Onsite training/onboarding will be required.
Qualifications:
Recent experience in hospital billing required. Critical Access and/or Rural Health Clinic experience a plus. Experience in charge capture, coding, revenue cycle management, patient accounting and/or physician billing a plus.
Experience with EPIC EMR preferred.
Medical Terminology preferred.
High School Diploma required.
Responsibilities include: • Investigating & resolving claim denials • Identifying denial patterns and managing insurance project resubmissions with multiple claims • Validate denial code/reasons following explanation of benefit (EOB) review and ensure coding is accurate and reflects the procedures billed • Analyze all coding adjustments made on EOB to ascertain accuracy and valid support • Review Summary Plan Descriptions and related insurance documents to ascertain benefits • Determine and execute best approach for denial resolution and processing appeal • Ensure timeliness of all appeals according to Federal, State and plan guidelines • Generate appeals based on the dispute reason(s) • Document all actions taken during the appeal process and any follow-up required • Request and obtain medical records, notes and/or copy of claim as appropriate • Resolve appeal claims with third party payers
Knowledge, Skills & Abilities: • Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements. • Knowledge and use of payer medical policy and Medicare LCD/NCD criteria. • Knowledge of billing and coding requirements • Must have the ability to effectively utilize Microsoft Office • Must possess excellent verbal, written and interpersonal communication skills, and able to balance multiple demands and respond to time constraints. • Must have high-level skills in organization as well as problem solving and analytical skills. • Capacity to manage time effectively, attention to details, and follow through. • Well-developed research skills. • Advanced technical skills to quickly learn hospital information systems • Knowledge of contracting and credentialing implications on revenue cycle functions
The Medical Biller is responsible for preparing, reviewing, correcting, and updating insurance claims for submission to payers,
Typical Schedule:
Full Time, Monday through Friday, Days
Onsite training/onboarding will be required.
Qualifications:
Recent experience in hospital billing required. Critical Access and/or Rural Health Clinic experience a plus. Experience in charge capture, coding, revenue cycle management, patient accounting and/or physician billing a plus.
Experience with EPIC EMR preferred.
Medical Terminology preferred.
High School Diploma required.
Responsibilities include: • Investigating & resolving claim denials • Identifying denial patterns and managing insurance project resubmissions with multiple claims • Validate denial code/reasons following explanation of benefit (EOB) review and ensure coding is accurate and reflects the procedures billed • Analyze all coding adjustments made on EOB to ascertain accuracy and valid support • Review Summary Plan Descriptions and related insurance documents to ascertain benefits • Determine and execute best approach for denial resolution and processing appeal • Ensure timeliness of all appeals according to Federal, State and plan guidelines • Generate appeals based on the dispute reason(s) • Document all actions taken during the appeal process and any follow-up required • Request and obtain medical records, notes and/or copy of claim as appropriate • Resolve appeal claims with third party payers
Knowledge, Skills & Abilities: • Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements. • Knowledge and use of payer medical policy and Medicare LCD/NCD criteria. • Knowledge of billing and coding requirements • Must have the ability to effectively utilize Microsoft Office • Must possess excellent verbal, written and interpersonal communication skills, and able to balance multiple demands and respond to time constraints. • Must have high-level skills in organization as well as problem solving and analytical skills. • Capacity to manage time effectively, attention to details, and follow through. • Well-developed research skills. • Advanced technical skills to quickly learn hospital information systems • Knowledge of contracting and credentialing implications on revenue cycle functions