Job Summary:
The Medical Billing Representative is responsible for submitting claims to insurance companies, following up on unpaid claims, and ensuring accurate billing of medical services provided by the organization. This role plays a crucial part in the revenue cycle, ensuring timely and accurate reimbursement for services.
Key Responsibilities:
Claims Submission:
- Receives and review charge documents and messages from healthcare providers.
- Prepare and submit claims to insurance companies for reimbursement based on services provided to patients.
- Ensure claims are complete and compliant with insurance guidelines.
- Ensure that coding for procedures and services provided is accurate and up to date with the latest coding standards (CPT, ICD-10, HCPCS).
- Work with healthcare providers and coders to ensure proper coding for all billed services.
Billing and Aging Management:
- Conducts detailed investigations to gather all necessary information for accurate billing.
- Involves ensuring that all charges for services rendered are billed correctly to the appropriate payer (private insurance, Medicaid, hospice, etc.), this includes processing claims, submitting invoices, and ensuring that payment is collected for the services provided. All these are done within set timelines.
- Initiates calls for private/income, Medicaid or hospice payment collections
- Monitors outstanding payments and overdue invoices, categorized by how long they’ve been unpaid and makes a follow up to ensure timely payment.
Denials and Reconciliations:
- Review and post denial codes or Explanations of Benefits (EOBs).
- Investigate and resolve discrepancies in payments, underpayments, or misapplied payments.
- Communicate with insurance companies and/or internal departments to resolve issues regarding underpayments, claim denials, or missing payments.
Billing Reports & Documentation:
- Enters charges and actions related to patient accounts accurately into the electronic health record (EHR) system.
- Generate and review billing reports to ensure accuracy and completeness.
- Maintain organized patient billing records, including claims, payment history, and correspondence with insurance companies.
Payment Posting
- Post insurance and patient payments received through Electronic Funds Transfers (EFTs), checks, or credit cards into the billing system.
- Conducts bank reconciliation, including monthly & weekly tie-out
Customer Service:
- Provide excellent customer service to patients regarding billing inquiries, insurance claims, and payment plans.
- Assist patients with questions related to insurance coverage and billing statements.
- Responds to inquiries via email and phone calls from patients, family members, facility personnel, etc.
Compliance & Regulations:
- Stay updated on changes in billing regulations, insurance requirements, and coding standards.
- Ensure all billing procedures comply with healthcare regulations and patient confidentiality laws (HIPAA).
Education and Skill Requirements:
- Proven work experience in medical billing for at least 3years required
- With SNF and PCC experience
- Strong understanding of medical terminology, ICD-10, CPT codes, and insurance claims processing
- Familiarity with revenue cycle management, including handling payments and accounts receivable.
- Adaptability to learn new billing practices and technologies in the evolving healthcare industry.
- Meticulous attention to detail for accurate billing and documentation.
- Strong customer service skills for addressing inquiries from patients, family members, and insurance companies.
- Effective communication skills for interaction with patients and facility staff.
- Demonstrate ability to collaborate effectively with colleagues in the billing department and cross-functional teams.
- Proficient in time management, adept at prioritizing tasks efficiently.
- Capable of working effectively under pressure.
- Able to deliver results consistently in a fast-paced and hectic environment.
What We Offer:
At FGC+, we believe that every person yearns to fulfill their potential. “Igniting possibility” is our brand essence, it recognizes that work can be a great catalyst for personal and professional growth. By creating an environment of support and inspiration, we enable people to realize their true capabilities and to make work a source of fulfillment and sustainable success.
We offer more than just a job; we provide a nurturing environment where work-life balance, mentorship, employee engagement, and continuous learning are the pillars of your success — not to mention a market competitive total compensation/rewards package including:
- Day 1 HMO
- Competitive base pay with incentives and allowances
- Payment of all statutory government benefits
- 25 days of annual paid leave
- 13th month pay
- Onsite medical support
- Skills and training development programs
- Employee Engagement Events
- Employee Referral Program
EEO Statement:
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
Third-Party Agency Notice:
FGC+ will not accept any unsolicited resumes from any third-party recruiting agencies, either domestic or international. FGC+ nor its subsidiaries/LE’s will be responsible for any fees from the use of any unsolicited resumes either through our ATS or via electronic mail systems from any agen
