JOB SUMMARY

The Medical Biller is responsible for preparing claims for submission to the National Health Insurance Company as well as other private payers. The incumbent is responsible for timely submission of claims based on agreed submission terms with the insurance providers. He/ She is also responsible for following up on claims and processing resubmissions as required.

KEY ROLE ACCOUNTABILITIES

Releases completed claims for submission.
Requests additional information from clinical areas in response to claims denials or inquiries by insurance providers.
Prepares and processes claims based on claims work lists for submission to insurance providers or TPAs.
Verifies claims for accuracy and completeness of information.
Communicates with clinical areas to resolve any claim edits issues.
Ensures that claim formats concur with insurance provider requirements.
Prepares clean claims for electronic and/or manual submission.
Accesses Cerner Charge Services to produce and submit claims.
Follows up on submitted claims to ensure timely payment processing.
Contacts insurance providers or TPAs on as needed basis.
Identifies unpaid and partially paid claims and takes the necessary steps for appeal or resubmission.
Processes claim re-submission as required.
Posts insurance payments on the system.
Refers patient related liabilities to the AR Section for processing.
Escalates unresolved claims related issues to the Supervisor - Patient Billing and Revenue Reconciliation for further action.
Documents events and interactions using electronic and manual systems.
Maintains billing records in accordance with internal standards.
Adheres to Sidra’s standards as they appear in the Code of Conduct and Conflict of Interest policies
Adheres to and promotes Sidra’s Values

In view of the evolving needs and opportunities within Sidra, this position may be required to perform other duties as assigned and reporting relationships may vary.

WORK ENVIRONMENT THE ROLE OPERATES IN

Work is normally performed in an office environment
No or very limited physical effort is required
No or very little exposure to physical risk

ORGANIZATION VALUES

Trust: Being competent; acting consistently, reliably and predictably; acting with honesty and integrity; respecting patient, employee and commercial confidentiality; delivering on commitments

Care: Acting with empathy, kindness and compassion; being humble; listening and responding; acting with cultural sensitivity; Caring for patients and staff

Teamwork: Sharing information and knowledge and learning from demonstrated expertise; being respectful, and thereby earning respect of others; acting with professionalism; leading and following; collaborating and being accessible

Transparency: Frequent and honest communication; open access to information for decision making; willingly acknowledge shortcomings; speaking up about concerns; publishing performance indicators

Innovation: Freedom to innovate; welcoming ideas and encouraging creativity; supporting talent; creating confidence; celebrating successes

Efficiency: Providing measurable value; using data to drive decision making; having and achieving clear goals; building processes that work; continuously improving outcomes in patient and family care

QUALIFICATIONS, EXPERIENCE AND SKILLS – SELECTION CRITERIA
	ESSENTIAL	PREFERRED
Education	Bachelor Degree - Commerce, Health Information, or relevant discipline
Experience	2+ years’ of experience in medical billing using an electronic billing and insurance system	Hospital Experience Experience using Cerner Health Information System
Certification and Licensure		Medical billing certificate or other Revenue Cycle Certificate
Professional Membership
Job Specific Skills and Abilities	Demonstrated knowledge and skills with patient billing systems. Demonstrated ability in claims processing with patient insurance operations Demonstrated ability in verifying and ensuring claims eligibility verification Processes, basic health data and procedures Proficiency with Microsoft Office suite Fluency in written and spoken English	Working with Cerner Patient Billing Application Knowledge of CPT, ICD-10-AM, ACHI Coding and medical terminologies

Medical Biller-TEMP90113