Billing Representative

Responsibilities:
• Confirms insurance coverage. Determines necessity for pre-authorization and obtains authorization for scheduled procedures.
• Determines financial responsibility for services to be provided. Notifies patients and/or practitioners of any services requested and/or referred that are not authorized by     insurance.
• Communicates with patients and practitioners regarding financial responsibility and insurance coverage issues.
• Maintains detailed documentation in the patient account record of all billing activities. Maintains documentation of claims processed as part of the daily claims   reconciliation process.
• Prepares and completes claims for commercial insurance companies, third party organizations and/or government or self payers.
• Researches, analyzes and reconciles Medicare/Medicaid billing and reimbursement practices.
• Maintains detailed documentation in the patient account record of all billing activities. Maintains documentation of claims processed as part of the daily claims   reconciliation process.
• Consults with appropriate parties to resolve unbilled claims. Reviews recent accounts for proper billing practices and reimbursement.

Complexity of Work:
• Within scope of job, requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment. Must be able to speak, read, write and follow instructions in English

Personal Protective Equipment:
• Follows Standard Precautions using personal protective equipment as required.

Education:
• High school diploma or GED required.