Medical Biller - Full-time - Surgical Institute of Reading

• Collaborates with Insurance Coordinator on Insurance Authorizations, claim numbers and adjusters.
• Works with Pre-Admissions clerk of any cancellations and no show fees.
• Communicates with any and every Adjuster, Nurse Case Manager and Benefits Organizer for negotiations on services rendered.
• Collaborates with the Patient Accounting Coordinator, Business Office Manager and the CFO.
• Maintains diagnostic master file and CPT master file in accordance with SIS guidelines.
• Maintains (on an interim basis) the procedure code master file; evaluates and develops new entries.
• Interprets and enforces third party payer rules and regulations; including Medicare requirements.
• Works with physician offices to resolve coding issues.
• Responds to patient and family member questions and refers questions to healthcare providers when appropriate.
• Counsels patients about Facility charges such as financial obligations, explaining fees, and reimbursement process.
• Collects information for planning a payment schedule for the patient.
• Maintains knowledge of and complies with established policies and procedures.
• Audits accounts to assure compliance with applicable laws and regulations relative to fraud and abuse issues.
• Monitors Medicare reimbursements and maintains files.
• Knowledge of coding policies and procedures; established in accordance with HCFA and third party payers.
• Bills and follow-ups with third party payers and patients for services received in accordance to Facility Policy and Procedures.
• Maintains knowledge of Medicare and third party contracts as it relates to hospitals.
• Ensures all billing and coding requirements are completed which relate to month-end closing.
• Maintains a high level of proficiency in computer applications.
• Maintains the strictest confidentiality.
• Performs related work as required.

• High School Diploma or equivalent.
• Excellent communication skills using proper English grammar.
• Minimum 2 years of billing experience.
• Familiar with patient accounting software, especially AdvantX.
• Ability to read and understand insurance explanations of benefits and managed care contracts
• Knowledge of Internet Explorer, Microsoft Excel, Microsoft Word, and Outlook.

United Surgical Partners International