Job Description: This position is expected to have excellent reasoning skills based on knowledge of clinic operations as it pertains to billing claims to Insurance Health Plans, coding for medical diagnosis and procedural coding. Individual must be familiar with the conventions and instructions provided within the ICD disease classifications and CPT coding guidelines. Should be able to reason through insurance claims differences as defined by benefit and plan differences. This position is responsible for resolution of A / R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including local, state and federal regulations regarding billing and collection practices are followed, as well as with established internal policy and procedure. Additionally, this position may be responsible for any or all of the following: acting as a resource to other staff and clinics, timely billing or filing of claims for services rendered at the clinics, reviewing claims that are rejected / denied / not paid for errors or incorrect filing with the Carriers and Medicare, billing patients and collecting for fees deemed to be the patient’s responsibility, billing secondary insurance, data entry of encounter data (or fee tickets) from the Clinics, and Evaluation and Management Documentation Guidelines. Job Responsibilities: Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, Medicare, or patients. Able to apply correctly to claims / fee billed (Collector) Responsible for working EDI claim rejections in a timely manner Responsible for reporting payer payment and denial trends in a timely fashion Responsible for reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and procedures Processes incoming EOBs to ensure timely insurance filing or patient billing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance Verifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation (Biller) Review medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filed Responsible for reconciling transactions to ensure that payments are balanced Responsible for reviewing insurance payer reimbursements for correct contractual allowable amounts Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information Responsible for processing payments, adjustments and denials according to established guidelines (Payment Poster) Job Requirements: Knowledge of submission and resubmission of medical claims Coding certification Knowledge of government and commercial policies and procedures Skill in the operation of billing software and office equipment Skill in using Microsoft Office (Outlook, Excel, Word) 2+ years of related billing and / or collection experience Medical terminology and ICD / CPT coding Skill in processing claims efficiently and on a timely basis Technical skills in the areas of EDI, systems analysis and process flows 50 wpm typing skill Knowledge of HIPPA compliance rules and regulations Knowledge of ICD, CPT codes and HCPCS coding Qualification & Experience: Proficiency with Microsoft Office applications Strong attention to detail and professional customer service skills High school diploma or GED equivalent 3+ years of related billing and / or collection experience 4 - 5 years of relevant medical experience Job Details: Company: UnitedHealthcare Vacancy Type: Full Time Job Location: San Antonio, TX, US Application Deadline: N/A Apply Here careersvite.com
Careers Vite – Latest Jobs 2025