Billing & Reimbursement Job Description
Billing & reimbursement
provides support to the Billing Service Team by adding providers and payers, resolving data mapping issues, and making billing software configuration changes.
Billing & Reimbursement Duties & Responsibilities
To write an effective billing & reimbursement job description, begin by listing detailed duties, responsibilities and expectations. We have included billing & reimbursement job description templates that you can modify and use.
Sample responsibilities for this position include:
Acquires and maintains thorough knowledge of federal and state legislative and administrative action affecting physician and professional provider reimbursement
Facilitate the billing process between the company and their vendors
Resolve any discrepancies related to the revenue cycle between the company and their vendors
Preparation and analysis of billing, compliance, and aging reports
Maintenance of fee schedules and vendor master files
Facilitate the handling of all payer audits, such as CERT, RAC, OIG,MAC, Medicaid, , Maintain and distribute audit activity reports accordingly
Implement and maintain appropriate controls and safeguards
One call resolution
Verifies that batches received from billing areas are in balance on a daily basis
Direct the work flow and functional duties of support personnel and processes for chart acquisition across our service lines, generating accurate claim information for services provided
Billing & Reimbursement Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Billing & Reimbursement
List any licenses or certifications required by the position: CPC, RHIT, RHIA
Education for Billing & Reimbursement
Typically a job would require a certain level of education.
Employers hiring for the billing & reimbursement job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Business, Finance, Accounting, Medical Billing, General Education, Education, Healthcare, Public Administration, Management, Human Resources
Skills for Billing & Reimbursement
Desired skills for billing & reimbursement include:
Key working relationships to be able to interact with billing and cash teams
Hard copy billing plans
Insurance coding and billing procedures
Microsoft Excel
Carrier contracts/changes and departmental policies and procedures
Experience with government segment and Managed Care payers
Experience with public & private Managed Care payers and reimbursement process
Billing and collection processes and general supervision for routine work
Federal
Healthcare terminology and medical billing
Desired experience for billing & reimbursement includes:
Oriented and strong organizational skills
On quality and service
Knowledge and experience working with appeals
Ability to communicate effectively with clients and all levels of staff
2+ years of experience working in a healthcare billing/reimbursement environment
Collections experience in insurance/healthcare environment preferred
Billing & Reimbursement Examples
1
Billing & Reimbursement Job Description
Job Description Example
Our company is searching for experienced candidates for the position of billing & reimbursement. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for billing & reimbursement
- Monitor matrix information and production flow to assimilate a smooth and standard workflow
- Analyze volume for efficient planning and assignment throughout specialty divisions
- Identify trends in all functional areas to allow for training, development and continuous process improvement utilizing Lean tools and principles
- Stay abreast of all reimbursement department functions and industry trends to optimize functionality within the external revenue cycle
- Maintain and monitor internal controls as set forth by senior management
- Provide support for other external business needs as needed
- Performs error analysis for disputed/denied claims and provides recommendations for process improvements
- Acts as a resource for information on public/private payer assistance and guidelines
- Informs supervisor of difficult collection issues and patterns of non-payment
- Advises supervisor of computer generated inaccuracies or required program changes
Qualifications for billing & reimbursement
- Of others
- Current Credentials in Professional Charge Coding ( CPC)
- Progressively responsible business and administrative experience in health care including physician group practice
- MBC diploma/cert or higher (Associate degree preferred)
- Two years of work experience in the field (hospital, physician office, billing center, medical records
- 10 or more years of progressive experience within a large healthcare company
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Billing & Reimbursement Job Description
Job Description Example
Our company is growing rapidly and is hiring for a billing & reimbursement. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for billing & reimbursement
- Maintains acceptable standards of attendance, punctuality and dependability
- Drafts and distributes professional correspondence and announcements
- Review, compare and coordinate EOBs, payments, denials, underpayments
- Review billing, payment and bad debt histories with management
- Document and update all files ongoing
- Manages portfolio of client accounts within Reimbursement Office policy and procedure guidelines
- Build and maintain relationships with payor representatives
- Submit accurate and timely Clean Claims for the required invoice type (CMS 1500, 835 – Electronic Medical Claims, and NCPDP 5.1 – Pharmacy)
- Resubmit claims as appropriate
- In a fast paced, call center environment, candidates will be responsible for preparing and reviewing claims to ensure billing accuracy according to payor requirements, including but not limited to codes, modifiers, pricing, dates and authorizations
Qualifications for billing & reimbursement
- Team leadership skills, team builder, and team player with a track record in strategic planning and execution, in formulating revenue cycle policy, developing and implementing operational plans, new strategies and procedures
- Flexible and adaptable to learn and understand healthcare billing trends and solutions, staying abreast of new healthcare billing regulations and laws
- Able to effectively track, prioritize, and execute tasks in a high-pressure environment
- Actively promote a knowledge-sharing environment with team members
- Ability to adapt and interact with all levels of the organization through the use of exceptional interpersonal, organizational development, training and communication skills
- Ability to break down communication and departmental silos and build bridges
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Billing & Reimbursement Job Description
Job Description Example
Our growing company is looking for a billing & reimbursement. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for billing & reimbursement
- Identifies and communicates changes that impact coding, medication order templates including development of appropriate coding for new services and procedures provided by clinicians
- Investigates and responds to questions regarding documentation and coding issues
- Coordinates the review of medical records and financial accounts with coding department and providers to maximize reimbursement
- Keeps apprised and provides up-to-date information regarding compliance and regulatory/payor requirements pertaining to the coding and reimbursement of medication administration
- Reviews high dollar accounts to ensure correct and timely follow-up by billing vendor, provides recommendations for account follow up
- Reviews government and commercial payer rules, regulations and standards that apply to professional billing activities, provides feedback and recommendations to management
- Reviews REQ accounts and resolution and conducts analysis identifying root cause of denials, provides comprehensive report to AR manager, summarizing findings to include denials and appeals trends
- Track and reconcile all Department of Defense administrative fees
- Process manual billings
- Process and complete void reissue and manual check requests
Qualifications for billing & reimbursement
- Motivated by and excel at training and developing staff
- Well versed with Microsoft Office Suite products
- Minimal travel required, but must be able to when necessary
- Bachelor's Degree from four-year College or University and 10 or more years of experience
- Knowledge of Medicare reimbursement practices preferred
- Experience with Managed Medicare payers preferred
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Billing & Reimbursement Job Description
Job Description Example
Our company is growing rapidly and is looking for a billing & reimbursement. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for billing & reimbursement
- Appropriately identify, address, submit or process adjustments, over payments, and outstanding balances
- Provide timely orientation and continuing education to physicians, staff and administrators on charge capture, medical documentation, coding and reimbursement policies, procedures, practices and systems
- Assist division administrators in responding to charge and revenue related issues
- Act as a liaison between the clinical areas and the Facility CDM coordinators in developing recommendations for the establishment and revision of procedure codes and proposed fees
- Maintain close working relationship with Central Coding Unit Leadership/Managers, coding staff and act as a liaison between assigned divisions and coding
- Provide continuing education to physicians, advanced practice providers, administrators and staff on charge capture, medical documentation, coding and reimbursement policies, procedures, practices and systems
- Ability to know when to escalate delinquent and/or complex claims to Sr
- Partner with Contract Managers and Managed Care on the contracting process including review of documents as necessary
- Guide contract implementation (internally and with billing partner), and updating relevant systems to reflect contract terms
- Develop and execute implementation plans with Billing and Reimbursement Management and billing partner for initiatives such as new contracts/policies, new billing codes and other as needed to support the business
Qualifications for billing & reimbursement
- Associate degree in Finance, Accounting, or related curriculum preferred
- Knowledge of contract terminology preferred
- Ability to use Microsoft Software
- Requires one year coding experience
- Bachelors degree in Finance, Accounting or Healthcare Administration
- Currently enrolled in a four year college degree (Accounting, Finance or Business major)
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Billing & Reimbursement Job Description
Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of billing & reimbursement. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for billing & reimbursement
- Participate in the development and maintenance of a contract database and contract management system
- Analyze data to identify negative revenue pull-through scenarios specific to payers and across payer segments
- Develop and leverage relationships with billing operations staff at payers as necessary to resolve claims adjudication (contractual and non-contractual) issues
- Partner with Managed Care team on development and rollout of new processes and reporting tools that address implementation and pull-through activities
- Identify broad revenue opportunities that span a customer segment
- Facilitate conversations with appropriate GHI personnel early in the contracting process to provide an overview of account performance to avoid delay in contract implementation
- Engage with GHI/billing partner, Managed Care and payers’ operations personnel as necessary to implement contract requirements
- Participate in on site meetings at billing partner facility such as quarterly meetings and monthly close meetings as needed
- Assume revenue pull-through responsibility post contract execution and synthesize lessons learned to update implementation and/or pull-through processes as needed
- Support execution of revenue pull-through plans to meet quarterly revenue goals and revenue reporting needs, as required from Finance
Qualifications for billing & reimbursement
- Responsible for scanning documents into scanning database by assigning batch number and batch labels based on defined naming convention to ensure the documents are easily accessible through defined search techniques
- Assists others in locating scanned documents involving complex searches
- Responsible for preparing paper claims to be filed to the insurance payers by editing the claims as required by the payers and attaching EOB copies as necessary
- Files all scanned documentation and prepares documents for off-site storage
- Proficient in use of Microsoft Office, particularly Excel
- One year experience in accounts receivable, banking, or office setting preferred