Robert Half

The Billing Representative plays a crucial role in ensuring accurate and timely medical billing functions within the Billing and Collections department.. Handle Optum Care patients’ protected health information (PHI) in accordance with HIPAA standards.. Serve as a resource to Optum Care staff on general billing guidelines.. Previous experience with Allscripts, eCW, Athena, or RCX systems.. Experience with PCP and Hospitalist billing and coding.

billing representative

The Billing Representative plays a crucial role in ensuring accurate and timely medical billing functions within the Billing and Collections department. Reporting to the Billing Manager, this position involves interacting with customers and ancillary departments to gather support data, manage invoice preparation, and reconcile billing with accounts receivables. The ideal candidate will demonstrate superior customer service skills, attention to detail, and a commitment to maintaining confidentiality and compliance with HIPAA standards. Essential Functions:<ul><li>Provide superior customer service to internal and external customers, demonstrating care and concern in all interactions.</li><li>Represent the company professionally and adhere to all policies and procedures.</li><li>Handle Optum Care patients’ protected health information (PHI) in accordance with HIPAA standards.</li><li>Establish and maintain positive working relationships with staff and management.</li><li>Ensure timely submission of primary and secondary claims.</li><li>Maintain current knowledge of CPT and ICD 10 codes, required modifiers, and encounter data.</li><li>Perform electronic claims submission and address issues arising from erroneous codes or missing information.</li><li>Analyze billing discrepancies and seek assistance from internal and external stakeholders to resolve issues.</li><li>Review insurance claim forms for accuracy and completeness, making necessary corrections.</li><li>Apply knowledge of Medicare and Medicaid guidelines to review claims and ensure appropriate use of modifiers and codes.</li><li>Communicate system and claim formatting issues to the IT department and Billing Manager.</li><li>Serve as a resource to Optum Care staff on general billing guidelines.</li><li>Perform quality checks on data entries and inform customers/payers of billing problems or resolutions.</li><li>Maintain an understanding of state and federal regulatory requirements related to billing operations.</li><li>Conduct training for co-workers on accessing, reviewing, and submitting claims for payment.</li><li>Demonstrate dependability, organization, and the ability to perform additional duties as assigned.</li></ul> Education:<ul><li>High school diploma, G.E.D., or equivalent required.</li><li>Some college education is preferred.</li></ul> Experience: Minimum:<ul><li>CMC or CPC-A Certification.</li><li>Over 1 year of related job experience.</li><li>Experience with CPT/ICD 10 codes.</li></ul> Preferred:<ul><li>CPC Certification.</li><li>Previous coding experience.</li><li>Experience with HMO/managed care, Medicare.</li><li>Previous experience with Allscripts, eCW, Athena, or RCX systems.</li><li>Experience with PCP and Hospitalist billing and coding.</li></ul>

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