Senior Medical Billing Executives

Ascribe Healthcare Solutions

A Sr. medical biller is responsible for submitting & resubmitting medical claims to insurance companies and payers on behalf of the hospital. The main purpose of the role is to adjudicate and process the account/claim with quality in a professional manner according to policy terms and conditions. The medical biller will hold responsibility for the account/claim until payment is done. He/ She needs to apply the clinical guideline and sound judgment of medical necessity when assessing the account. Additionally, the role will need to interpret and process claims with correct usage of standard codes (e.g. ICD, DRG, CPT, and HCPCS) applicable billing structure, policy terms, and benefits. Ensure that all medical information is kept confidential as per compliance.

Roles and Responsibilities

• Reviewing patient bills for accuracy and completeness, and obtaining any missing information

• Evaluates and processes claims per insurance policy terms and conditions

• Work per company policies and procedures

• Identify and report back any type of claims observation or issues that may affect the process

• Evaluates and ensures that all claims denied or underpaid inappropriately by Payers are identified, appealed and reversed

• Reviewing claims to make sure that billing requirements are met, updates accounts as necessary, answers inquiries and makes recommendations for resolution

• Ensures that targets are met for department Turnaround time, Quality and Productivity

Education, Experience, and skills needed

• Expert knowledge of medical conditions, treatments, procedures and standard codes

• Willingness to work in different shifts

• Willingness to work from a different facility

• Analytical skills to review the account before submission to payer and ensure all required data elements are correct as per the insurance and medical code sets

• Basic understanding of the billing and payer adjudication guidelines related to DHA

• Basic knowledge of medical terminology

• Proficiency in the use of PCs and MS Office suite

• Excellent in communication skills

• Understanding of the various RCM departments