Medical Billing Rep II

Schedule Monday - Friday (40 hrs/wk) 8:00 AM - 4:30 PM Department Payer Relations - 936 Primary Purpose Perform functions related to the Billing or Payer Relations departments, including billing, claims management, and client communication. Essential Functions Handle delegated billing areas and manage claims (submission, follow-up, and collection). Identify and solve problems pertaining to assigned accounts. Prepare and review the Aged Trial Balance (ATB) report. Initiate follow-up on past due accounts. Act as a point of contact for clients, insurance companies, patients, the third‑party billing vendor, and other departments to address billing questions, resolve discrepancies, and facilitate payments. Answer or forward personal, and department emails/faxes/mail/calls/voicemail to the correct recipient. Review and refer to past due accounts to the collection agency. Participate in ongoing training as it relates to job functions or company requirements. Read payer contracts and communicate with the payer about any noncompliance approve adjustments up to $100.00. Review and approve refunds. Research front end edits and either correct the error or bill the charges to the client. Request medical records from clients and print test results. Move charges from client to patient billing and vice versa (retier charges). Enter demographic and insurance information into the system. Review records for data accuracy and communicate missing information with clients and patients. Identify and correct errors on claims that were denied or rejected by insurance companies, then resubmit them for payment or appeal. Submit and follow‑up on prior authorization requests. Communicate insurance company’s decision to clients. Research ABN report and communicate results with third party billing vendor. Prepare reports and correct billing in relation to those reports. Create, modify, or inactivate payers. Map client health plans to system payers. Maintain the third‑party billing fee schedule in accordance with hotlines, CPT updates, and annual updates. Adhere to all relevant regulations to ensure proper billing. Respond to payer audits. Other duties as assigned. Physical and Other Requirements Stooping: Bending body downward and forward by bending spine at the waist. Reaching: Extending hand(s) and arm(s) in any direction. Mobility: The person in this position needs to occasionally move between work sites and inside the office to access file cabinets, office machinery, etc. Communicate: Frequently communicate with others. PPE: Biohazard laboratory environment that requires use of personal protective equipment in accordance with CDC and OSHA regulations and company policies. ARUP Policies and Procedures: To conduct self in compliance with all ARUP Policies and Procedures. Medium Work: Exerting up to 50 pounds of force occasionally, and/or up to 30 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects. Fine Motor Control: Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand as in handling. Vision: Having close, far, and peripheral visual acuity to perform a variety of tasks such as make general observations of depth and distance. Qualifications Education High School Diploma or Equivalent or better. Experience Two to three years of experience in a billing department. Knowledge of CPT, and ICD10 codes. Knowledge of CMS LCDs, NCDs, and Medicaid regulations. Advanced computer skills with an emphasis on billing. Advanced skills/knowledge Microsoft Office Suite. Preferred 10‑Key skills by touch. Certified Professional Coder. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr