双语医疗账单处理员（英语和西班牙语熟练）
Bilingual Medical Biller (English & Spanish Proficiency)
职位概述
医疗账单专员负责管理完整的医疗账单流程，确保准确提交索赔、及时报销，并符合美国医疗账单法规。该职位需要与医疗机构、保险公司和内部团队紧密合作，解决账单问题，减少索赔拒付，并优化收入周期表现。
主要职责
1. 索赔处理与提交
- 准备、审核并向保险公司提交准确的医疗索赔（电子版和纸质版）。
- 在提交前确保正确的编码（CPT、ICD-10、HCPCS）和账单合规性。
- 在账单前验证患者保险资格和福利。
2. 收款记录与对账
- 将保险和患者的付款准确录入系统。
- 对账付款与索赔，识别差异。
- 必要时处理调整、核销和退款。
3. 拒付与跟进
- 监控未支付的索赔，并与保险公司跟进以解决问题。
- 调查被拒或被拒绝的索赔，并在适用情况下发起申诉。
- 维护结构化的跟进流程，确保及时报销。
4. 应收账款（AR）管理
- 跟踪和管理逾期报告，减少未结余额。
- 优先跟进高价值和逾期的索赔。
- 与内部团队合作解决影响收款的账单问题。
5. 合规与文档
- 确保所有账单活动符合HIPAA和付款人特定指南。
- 保持准确且最新的账单记录和患者信息。
- 在审计中及时提供所需的账单文档。
6. 报告与沟通
- 生成定期的账单和AR报告供内部审查。
- 在必要时与患者沟通账单相关问题。
- 与医务人员、编码员和行政团队协作解决差异。
教育与经验
- 医疗保健管理、商业、金融或相关领域的学士学位（优先考虑）。
- 至少3年医疗账单或收入周期管理经验。
- 需要有在美国医疗系统和保险公司工作的经验。
技术技能
- 精通医疗账单软件（例如Kareo、AdvancedMD、Athenahealth、eClinicalWorks）。
- 熟悉CPT、ICD-10和HCPCS编码系统。
- 精通Microsoft Excel。
查看英文原文
Job Overview
The Medical Biller is responsible for managing the end-to-end medical billing process, ensuring accurate claim submission, timely reimbursements, and compliance with U.S. healthcare billing regulations. This role involves working closely with healthcare providers, insurance companies, and internal teams to resolve billing issues, reduce claim denials, and optimize revenue cycle performance.
Key Responsibilities
1. Claims Processing & Submission
- Prepare, review, and submit accurate medical claims (electronic and paper) to insurance companies.
- Ensure proper coding (CPT, ICD-10, HCPCS) and billing compliance before submission.
- Verify patient insurance eligibility and benefits prior to billing.
2. Payment Posting & Reconciliation
- Post payments (insurance and patient) accurately into the system.
- Reconcile payments against claims and identify discrepancies.
- Process adjustments, write-offs, and refunds where necessary.
3. Denials & Follow-Ups
- Monitor unpaid claims and follow up with insurance companies for resolution.
- Investigate denied or rejected claims and initiate appeals where applicable.
- Maintain a structured follow-up process to ensure timely reimbursement.
4. Accounts Receivable (AR) Management
- Track and manage aging reports to reduce outstanding balances.
- Prioritize high-value and aging claims for follow-up.
- Collaborate with internal teams to resolve billing issues impacting collections.
5. Compliance & Documentation
- Ensure all billing activities comply with HIPAA and payer-specific guidelines.
- Maintain accurate and up-to-date billing records and patient information.
- Support audits by providing required billing documentation promptly.
6. Reporting & Communication
- Generate regular billing and AR reports for internal review.
- Communicate with patients regarding billing inquiries when necessary.
- Collaborate with providers, coders, and administrative teams to resolve discrepancies.
Education & Experience
- Bachelor’s degree in Healthcare Administration, Business, Finance, or related field (preferred).
- Minimum of 3 years of experience in medical billing or revenue cycle management.
- Experience working with U.S. healthcare systems and insurance payers is required.
Technical Skills
- Proficiency in medical billing software (e.g., Kareo, AdvancedMD, Athenahealth, eClinicalWorks).
- Strong knowledge of CPT, ICD-10, and HCPCS coding systems.
- Advanced skills in Microsoft Excel and Google Workspace.
- Experience with clearinghouses and EHR/EMR systems.
Key Competencies
- Attention to Detail: High accuracy in claim preparation and data entry.
- Analytical Skills: Ability to identify trends in denials and billing issues.
- Communication: Strong written and verbal English skills for payer and patient interactions.
- Organization: Ability to manage multiple claims, deadlines, and follow-ups efficiently.
- Problem Solving: Proactive in resolving billing discrepancies and reducing revenue loss.
Operational Requirements
- Stable internet connection (for remote roles).
- Ability to work within U.S. business hours (if required).
- Quiet and professional work environment.
Originally posted on Himalayas