PROFESSIONAL BILLER

Covenant HealthCare; Saginaw (MI); On-site; USD 25,000 - 34,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Retirement plan with employer match

Paid time off

Job summary

Covenant HealthCare is seeking a detail-oriented Medical Biller to ensure prompt and accurate billing and follow-up for hospital and related professional services. You will support Medicare, Medicaid, Blue Cross, commercial payers, and managed care programs, ensuring timely reimbursement and high-quality customer service.

Responsibilities include resolving patient billing inquiries, processing claims, and maintaining up-to-date knowledge of regulations and payer requirements.

Qualifications

• Third party billing and collections
• Knowledge of UB-94, CPT, ICD-9 Coding
• Knowledge of hospital and/or medical billing and insurance claim filing
• Insurance and/or account follow-up techniques
• Knowledge of medical and insurance terminology
• Minimal typing skills: 35 wpm
• Clerical skills: 10-key, computer, telephone, copier
• Good written and oral communication skills
• Team player with ability to work independently

Responsibilities

• Resolves patient billing inquiries and problems, follows up on balances due from insurance companies and patients.
• Assist patient/family with questions about their account regarding payment/reimbursement and setting up payment contracts.
• Performs insurance billing clerical duties including review and verification of patient account information against payer specifications.
• Enter data electronically to process charges, payments, denials and adjustments.
• Understand the Revenue Cycle.
• Maintain knowledge of Federal, State and local billing regulations and inform management of discrepancies.
• Complete and submit claims for payment, electronic or hard copy, including initial billing and follow-ups.
• Ensure accuracy and third party compliance in all billing activities including CPT/occurrence/condition codes, pre-certification or contractual adjustments.
• Adhere to all rules/regulations and respond to changes notified by carriers or government agencies.
• Understand relationship of timely claims follow-up to reduce days in accounts receivable and payer turnaround.
• Maintain understanding of HMO, PPO, or managed care contracts and verify correct payments/adjustments.
• Identify credit balance accounts and determine refunds or transfers.
• Report repeated errors or omissions of patient insurance and demographic information to the manager.
• Correct claims edits or errors promptly before submission.
• Prioritize issues and workload; work well in teams or independently.

Skills

Billing & collections

UB-94 / CPT / ICD-9

Hospital billing knowledge

Detail-oriented

Customer service

Education

Associates Degree preferred

Accounting / Information Systems background

Tools

Excel

Word

PowerPoint

10-key

Job description

Overview

The biller is responsible for prompt and accurate billing and follow-up for all hospital and related professional services provided to patients covered by third party payers, including: Medicare, Medicaid, Blue Cross, Commercial, Workers Compensation and all Managed Care Programs. Responsible to secure timely and accurate reimbursement from third party payers and patients based on appropriate billing and follow up activities. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant and the commitment to providing Extraordinary Care for Every Generation.

Responsibilities

Resolves patient billing inquiries and problems, follows up on balances due from insurance companies and patients.

Ability to assist patient/family with questions or concerns about their account as it pertains to payment/reimbursement and setting up payment contracts.

Performs insurance billing clerical duties including review and verification of patient account information against payer program specifications.

Enters data electronically to process charges, payments. denials and adjustments.

Understands the Revenue Cycle.

Maintains knowledge of Federal, State and local billing regulations, and informs management and compliance department of discrepancies.

Completes and submits claims for payment, electronic or hard copy, including initial billing, all insurance re-billing, and secondary or subsequent billings.

Responsible for accuracy and third party compliance in all aspects of billing activities in particular in relating to clinical attachments, cpt coding, occurrence, condition and value codes, pre-certification, contractual adjustments or required forms.

Strictly adheres to all rules/regulations and quickly responds to changes, as notified by insurance carriers, employers, third party payers, or government agencies.

Understands the relationship of timely and thorough claims follow-up to assist in the reduction of days in accounts receivable and payer turn around.

Maintains a thorough understanding of all HMO, PPO, or managed care contractual relationships and able to determine if correct payments and adjustments were made.

Ability to identify a credit balance account and make the correct determination as to whom/where the credit balance should be refunded or transferred.

Reports all repeated errors or omissions of patient insurance and demographic information to the manager.

Corrects all claims edits or errors promptly and before submission.

Prioritizes issues and workload effectively.

Works effectively as both a team member and one on one

Ability to communicate effectively both verbally and in writing

Qualifications

KNOWLEDGE/SKILLS/ABILITIES

Strong working knowledge of departmental policies, procedures and business operations and how they interrelate to other departments in the organization

Third party billing and collections

Basic understanding of UB-94, 1500,CPT, ICD-9 Coding.

Knowledge of hospital and/or medical billing and insurance claim filing.

Insurance and/or account follow-up.

Knowledge of medical and insurance terminology.

Minimal typing skills of 35 words/ minute.

Prefer a strong working knowledge of Excel, Word, PowerPoint Must possess clerical skills:10-key, computer, telephone, copier

Must have good written and oral communication skills

Must be a team player with the ability to work independently as well as in small or large teams

Protects and maintains the confidential nature of information

EDUCATION/EXPERIENCE

Associates Degree preferred.

Must have some post HS education, preferably in accounting, information systems or third party billings.

Must have a minimum of 18-24 months of relevant work experience or equivalent combination of training and relevant work experience.

Hospital billing and insurance claim processing experience preferred.

Insurance and/or account follow-up techniques experience preferred.

Why Work at Covenant HealthCare

At Covenant HealthCare, we are united by a shared mission of providing Extraordinary Care for Every Generation. We foster a culture built on teamwork, excellence, accountability, respect, customer service, and enthusiasm, where every employee plays an important role in delivering patient-centered care and making a difference in our community.

Our benefits include:

• Comprehensive medical, dental, and vision coverage
• Retirement plans with employer match
• Paid time off to support work-life balance
• Employee wellness programs and mental health support
• Tuition reimbursement, university discounts, and professional development opportunities