Medical Biller SME - Hybrid
HybridPasig, Central Luzon, Republic of the Philippines or Pasig, Bicol, Republic of the Philippines
Job Summary
Post medical charges, payments, and journal entries to patient accounts while verifying insurance filing information and receipt of patient registration data. Prepare, review, and transmit claims using billing software, including electronic and paper processing, followed by eligibility checks and benefit verification. Track unpaid claims within the standard billing cycle and research appeals for denied claims. Call insurance companies to obtain claim status, document findings, and handle precertification requests. Review patient bills for accuracy, obtain missing information, and ensure all protected health information is handled in compliance with HIPAA.
Required Qualifications
- Ability to handle protected health information in a manner consistent with the Health Insurance Portability and Accountability (HIPAA)
- Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid
- Able to perform eligibility verification, precertification, through the web or verbally with insurance companies
- Calling insurance companies and obtaining claim status with different payers & documenting it in the system
- Should be able to read superbills and make charge entry in PMS
- Ability to post ERA (Electronica Remittance Advice) & EOB (Explanation of Benefits) from various systems and websites
- Credentialing knowledge would be an added advantage
- Denial management should be known
Desired Qualifications
- Credentialing knowledge would be an added advantage
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