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Full Job Description
Overview:
The VRI Biller is responsible for validating, preparing, and submitting accurate and timely claims via the designated clearinghouse application to government and third-party payors. This role will be responsible for verifying client eligibility, validating feescharges, entering accurate information into billing systems, developing contacts with payor’s billing department for billing purposes. The VRI Biller is responsible for processing all billing effectively and efficiently to facilitate prompt payment for service. The Biller must demonstrate customer focus and expert functional/technical skills to effectively communicate with case managers, agency contacts, sales representatives, clients and team members.
Responsibilities:
- Assumes responsibility for timely and accurate submission, including generating monthly charges and transmission claims through the clearinghouse application.
- Collects and records accurate information.
- Communicates with agencies and clients regarding services.
- Resolves problems by clarifying issues, researching and exploring answer and alternative solutions, implementing solution and /or escalating unresolved.
- Completes the analysis of claim rejections and provides feedback to management for solutions and process improvements.
- Utilizes multiple system applications to work through assigned inventory.
- Focuses on completion of task prior to claim filing with little to no follow up after the billing of a client.
- Daily works through reporting cards, claim rejections and tickets assigned through company applications.
- Accesses payer portals to submit and collect need information to ensure timely processing of services provided.
- Adds and understands specific data such as modifiers, payer specific information, including authorization criteria, CPT and ICD-10 coding.
- Utilizes the phone system application by logging in and setting a status of ready, to assist clients/payers/CM’s calling into or transferring over on the RCM phone line.
- Manages incoming phone calls by responding to request and assisting with inquiries and noting the billing system with a summary of the call and actions.
- Effectively communicates utilizing telephone, form letters, email, or internal correspondence to resolve inquiries and issues.
- Follows department policies and procedures to ensure accurate and timely resolution.
- Maintains access to, and security of, highly sensitive materials.
- Maintains protocol information supplied from reference materials, memos, and training sessions.
- Maintains project productivity and quality goals including department, team and personal metrics.
- Other duties as assigned.
Qualifications:
- Required High School Diploma or GED
- 2 years of related professional experience preferred
- Experience with CareVoyant and Brightree preferred
- Ability to work flexible hours and overtime when needed
- Self-motivation and the ability to work independently and with teams
- Proficient in the use of Word, Excel, Outlook, and PowerPoint
- Excellent oral and written communication skills
- Proficient in managing multiple tasks as the same time
- Knowledge of medical claims or billing experience
- Experience with Authorization process and procedures
- Must have analytical skills to resolve simple to semi-complex problems
