JOB SUMMARY Job Class: Biller I-II-III-IV Department: 9630- Patient Accounts / 9630- Clinic Management CORE DUTIES AND RESPONSIBILITIES Demonstrates Competency in the Following Areas: GENERAL FUNCTION: This training position is accountable for learning how to process all commercial insurance claims accurately and timely on 1500 and UB04 forms. Commercial insurance claims include: Blue Cross, Workmen’s Comp, HMO & PPO insurances, Champus, Contractual policies, etc… Timely follow-ups on claims to ensure payments are received.
JOB DUTIES:
- Maintain established policies and procedures, objectives, quality assurance program and safety standards.
- Research all information to complete billing process.
- Accurate filing of all claims.
- Answer any inquiries regarding billing of accounts.
- Maintain department records, reports, and files as required.
- Participate in educational programs and in-service meetings.
- Perform other job duties as assigned or requested.
MINIMUM QUALIFICATIONS:
- Must be able to type 30 wpm with computer skills
- Must be able to read and write and have good communication skills
- Billing experience preferred
TRAINING TIERS A Biller I is considered a trainee. A trainee has three (3) months in which to demonstrate competency on three (3) of the following skills. Should the trainee not meet this goal, they may be transferred to a lesser position, retrained or terminated
- Create Encounter
- Key Changes
- Verify Insurance
- Release Charges
- Correct Rejections
- Answer Phones
A Biller I/Trainee has six (6) months in which to demonstrate competency in all of the above areas. Once demonstrated, trainee will be moved to a Biller II. Should the trainee not meet this goal, they may be transferred to a lesser position or terminated.
A Biller II has six (6) months from becoming a Biller II to demonstrate competency in three (3) of the following skills:
- AR Follow Up
- Work Denials
- Review Claims and make necessary corrections
- Follow up on insurance
- Make Corrections
The Biller II will be moved to a Biller III. Should the Biller II not meet this goal, they may be transferred to a lesser position or terminated.
A Biller III has six months from becoming a Biller III to demonstrated competency in all areas listed for the Biller II. A Biller III will be moved to a Biller IV when all areas are mastered.
CONTACTS:
- Within organization—all departments
- Outside organization—insurance companies, doctor offices, nursing homes, patient employers, vocational rehabilitation, and welfare department.
DECISION MAKING:
- Decision taken to supervisor for approval:
- ETO Time
- Clarification of changes of a procedure
