Prairie Ridge Health is looking for a new team member to join our Business Services Department in the role of Biller and Insurance Specialist. This position is the biller for patients and Health Plans; Government programs; Medicare, Medicaid, military and veterans’ health care programs, Third Party Administrators (TPA), Worker’s Compensation and commercial lines of business including primary and secondary insurance payers...….

Position Description:

This position is the biller for patients and Health Plans; Government programs; Medicare, Medicaid, military and veterans’ health care programs, Third Party Administrators (TPA), Worker’s Compensation and commercial lines of business including primary and secondary insurance payers. All of these will be hereinafter referred to as “Payers”. It is the primary liaison between patients and the organization regarding hospital and clinic billings, payments and collections. They are responsible for interactions with all Payers regarding timely and accurate claims filings, follow-up, appeals and applicable claims re-submissions. They oversee all aspects and edits of electronic and paper claims submissions and self-pay billings. They ensure billing compliance with federal guidelines and contractual agreements. They serve as a resource regarding the Centers for Medicare and Medicaid (CMS) guidelines for the business office and contractual agreements.  They also analyze insurance credit balances to ensure accurate and timely refunding to appropriate parties.

EDUCATION EQUIREMENTS/LICENSURE/CERTIFICATION/REGISTRATION    

• High school diploma (or equivalent).

• Experience paper and electronic billing for Medicare, Medicaid, managed care, commercial insurances and workers compensation; including knowledge of hospital and professional claim forms.   

•  Experience with revenue codes, CPT, HCPCs, and ICD-10 coding experience. 

•  Experience with medical terminology.

• Previous experience with health insurance, collection techniques, or patient registration.

• Must possess the ability to work both independently as well as a part of a team.  

• Intermediate proficiency with Microsoft Excel (or other spreadsheet software)

  Shift: Monday-Friday, days. 

FTE: 1.0

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