Position Summary:
We have an exciting opportunity to join our team as a Billing Representative III.

In this role, the successful candidate Under general direction submits claims. Follows-up on unpaid balances (insurance or patient), corrects errors, enters claim information, submits authorization/precertification requests with insurance companies, follows up on denied claims and/or authorizations, and submits appeals as necessary as a part of the revenue cycle team.

Job Responsibilities:

• Perform billing tasks assigned by management which may include data entry, claim review, charge review, accounts receivable follow-up, or other related responsibilities.
• Cross cover other areas in the office as assigned by management including Accounts Receivable/Denials, Customer Service or Authorizations.
• Make appropriate corrections to system to satisfy/edit payer requirements and re-submit claims as needed.
• Appeal complex denials through review of payer policies, coding, contracts, and medical records. Utilize subject matter experts as needed.
• Assist department supervisor on special projects and staff training.
• Responsible for assisting the professional billing staff within the CBO with difficult and escalated issues.
• Participate in workgroups and meetings. Attend all required training classes. Escalate issues to management as needed. Maintain confidentiality. Read and apply policies and procedures to make appropriate decisions. Coordinate functions and work cooperatively with others. Explain processes and procedures to others; performs other related duties as assigned.
• Work following operational policies and procedures, and regulatory requirements.
• Communicate with providers, patients, coders, or other responsible persons to ensure that claims are correctly processed by third party payers.
• Adhere to general practices and FGP guidelines on compliance issues and patient confidentiality.
• Review reports to identify revenue opportunities and unpaid claims.
• Utilize CBO Pathways as guide for determining actions needed to resolve unpaid or incorrectly paid claims and/or for authorizing procedures in assigned workqueue(s) using payer websites, billing system information and training within expected timeframe;
• Follow workflows provided in training classes and request additional training as needed.
• Identify payer, provider credentialing, and/or coding issues and address them with management.
• Perform daily tasks in assigned work queues and according to manager assignments.
• Provide input on system edits, processes, policies, and billing procedures to ensure maximization of revenues.

Minimum Qualifications:
To qualify you must have a High School Diploma or GED. Experience in medical billing, accounts receivable, insurance, or related duties; Knowledge of CPT and ICD10; medical billing software; English usage, grammar and spelling; basic math; 3 years experience in a similar role.