Job Summary:

Insurance Collector/Biller is responsible to submit patient claims timely and accurately to insurance carriers or governmental payers. The Insurance Biller/Collector follows up with assigned payers timely on unpaid claims to resolve any issues and facilitate payment processing of patient accounts.

Demonstrates through behavior Decatur Morgan Hospitals mission, vision and values.

Key Responsibilities / Essential Functions

1. Processes and validates claims via electronic submission or other acceptable payer specific methods.

2. Initiates follow up procedures on unpaid claims within defined timeline to insure timely payment is received.

3. Reviews various reports and identifies rejected or denied claims making appropriate corrections.

4. Communicates repetitive or unusual errors to manager and/or others to resolve problematic actions or activities which may be user or system driven affecting clean claim accuracy.

5. Utilizes Patient Accounting System applications appropriately as trained to gain maximum efficiency while billing and conducting follow up of patient accounts.

6. Responds to payer requests for additional information timely in order to facilitate claim processing and payment.

7. Reviews payer specific remittances to analyze and make corrections in order to re-bill/appeal or internally adjudicate claims in response to denials. Utilizes knowledge and experience to insure appropriate reimbursement is obtained and appropriate adjustments are processed.

8. Prepares transaction adjustment requests as may be necessary and attaches appropriate supporting documentation.

9. Applies notes to individual patient accounts that are informative, concise and facilitates corrected account resolution.

Minimum Knowledge, Skills, Experience Required:

Education: High school diploma or equivalent.

Experience: Minimum of one year working experience in hospital billing and collection processes. Physician office billing and collections may be considered. General applications with knowledge and skills to utilize Microsoft Office programs primarily Excel and Word as well as various applicable web based applications. Skilled in analytical account analysis and result oriented decision making.