VIVA Pediatrics Medical Biller / Claims Processor in Richardson, Texas
VIVA PEDIATRICS VIVA Pediatrics is a home health services company with a specialty in private duty nursing, therapy and skilled nursing visits for infants and children. We are committed to providing each patient with an exceptional level of care and attention. At our agency, we are proud to be nurse owned and operated. Our dedicated staff works together as a team to provide high-quality comprehensive care to medically fragile children. VIVA's core mission is to staff compassionate and understanding caregivers that take pride in paying close attention to each patient's needs.
1 | SUMMARY OF FUNCTIONS
Responsible for the timely submission of technical or professional medical claims to insurance companies including communications with physician offices, patients and staff.
2 | COMPETENCIES
- Passion, creativity, focus and positive attitude (i.e. customer service)
- Proper communication and documentation
- Dependability (i.e. attendance and punctuality, effective time management)
- Following policies and procedures
- Timely and accurate verification of notes
3 | MAJOR DUTIES AND RESPONSIBILITIES
- Reviews patient bills for accuracy and completeness and obtain any missing information and appeals to appropriate payer for reimbursement.
- Follows up on unpaid claims within standard billing cycle timeframe & appeal claims timely
- Ensures all claims billed timely
- Completes weekly billing reports
- Ensures reimbursement rates with payer’s are correct in management system
- Assists with verifying eligibility and benefits of payors on all clients
- Calls insurance companies regarding any discrepancy in payments if necessary
- Identifies and bills secondary or tertiary insurances
- All accounts are to be reviewed for insurance or patient follow-up
- Answers all patient or insurance telephone inquiries pertaining to assigned accounts
- Any and all account write-offs must be documented and signed by management
- Performs other duties as assigned
4 | ORGANIZATIONAL RELATIONSHIPS
Reports directly to the Billing Manager.
5 | SUPERVISORY RESPONSIBILITIES
6 | WORK ENVIRONMENT
This job operates in a professional office environment. This role routinely uses standard office equipment.
7 | PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to type, handle objects, tools or controls; reach with hands and arms; climb stairs; talk or hear.
8 | POSITION TYPE/EXPECTED HOURS OF WORK
This is a full-time position. Days and hours of work are Monday through Friday, 8:00 a.m. to 5:00 p.m. This position requires occasional long hours and possible weekend work.
9 | TRAVEL
10 | PREFERRED EDUCATION AND EXPERIENCE
- Bachelor's degree in business administration
- Experience in Accounts Receivable
Experience in health care field 11| ADDITIONAL ELIGIBILITY REQUIREMENTS
Ability to provide effective guidance, counsel, and influence at all levels of the organization
- Knowledge of insurance guidelines especially Medicaid
- Analytical skills
- Project management skills with proven ability to design and implement processes and solutions that drive results
- Team player with the ability to facilitate team building, develop effective partnerships and collaborate with a variety of stakeholders at all levels
- Ability to influence decision makers
- Proficient in Microsoft Office
12 | CLASSIFICATION