Medical Billing Executives

Overview

• A medical biller is responsible for submitting & resubmitting medical claims to insurance companies and payers on behalf of the hospital.
• The main purpose of the role is to adjudicate and process the account/claim with quality in a professional manner according to policy terms and conditions.
• The medical biller will hold responsibility for the account/claim until payment is done.
• He/ She needs to apply the clinical guideline and sound judgment of medical necessity when assessing the account.
• Additionally, the role will need to interpret and process claims with correct usage of standard codes (e.g.
• ICD, DRG, CPT, and HCPCS) applicable billing structure, policy terms, and benefits.
• Ensure that all medical information is kept confidential as per compliance.
• Roles and Responsibilities
• Reviewing patient bills for accuracy and completeness, and obtaining any missing information
• Evaluates and processes claims per insurance policy terms and conditions
• Work following company policies and procedures
• Identify and report back any type of claims observation or issues that may affect the process
• Evaluates and ensures that all claims denied or underpaid inappropriately by Payers are identified, appealed and reversed
• Reviewing claims to make sure that billing requirements are met, updates accounts as necessary, answers inquiries and makes recommendations for resolution
• Ensures that targets are met for department Turnaround time, Quality and Productivity