Billing & Claims Assistant- Physician Care, PC

The Billing and Claims Assistant assists the Patient Financial Services Manager in the daily operational billing processes for all hospital system service lines including, but not limited to: claims billing transmissions, returned or claims held for missing or invalid billing data, and compliance with all billing and reimbursement regulations for both governmental and nongovernmental payers.

• Assists in coordinating inter-departmental billing efforts and quantifying and addressing major charge, billing, and reimbursement.
• Maintains complete knowledge of all state, federal, and contracted third party regulations for billing and reimbursement for all payers. Informs manager of any opportunities available to enhance reimbursement in accordance with billing regulations. Successfully resolves matters with third party payers precluding optimal claim submission with third party payers.
• Interacts with various departments, exhibiting the knowledge and ability to implement coding rule revisions applicable for claim edit resolutions.
• Reviews billing processes and systems as directed, to determine the most effective and efficient methods and systems to ensure work stream success. Implements change as necessary.
• Monitors bill holds at all sources and ensures timely resolution. Works with other departmental managers in resolve. Reports unresolved issues and concerns impeding the billing process. Provides the Manager with weekly reporting of all bill hold activity by payer by reason including number and value of claims on hold and resolution actions taken to date.
• Acts as liaison with the electronic billing vendor/clearing house ensuring contract performance as specified. Periodically reviews other competitive products.

High school diploma or GED required. Minimum one year’s experience in Patient Accounts billing in a Healthcare setting required.

Knowledgeable in the reimbursement and billing guidelines for all major third party and governmental payers; Medicaid, Medicare, HMO’s; Commercial, Worker’s Compensation and Third Party Liability. Familiarity with healthcare medical terminology and coding. Knowledge of billing and patient accounting systems.

Excellent computer skills with proficiency in Microsoft Office Suite. Excellent verbal and written communication skills with active listening ability. Proficient in understanding, evaluating, and presenting analytical data.