SCOPE OF ROLE

The Biller Specialist is responsible for the accuracy of the super bill/claim prior to transmission to payer, including validation of appropriate Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). This is not a remote position and will require associate to commute to Centrum Medical Corporate Office.

ROLE RESPONSIBILITIES

• Assign/remove CPT, HCPCS and modifiers as part of the super bill/claim validation process.
• Prepare and review super bill/claims prior to submission.
• Identify coding trends and opportunities to improve quality, efficiency and productivity
• Checking each insurance payment for accuracy.
• Ensure compliance with billing and payers guidelines
• Calling insurance companies regarding any discrepancy in payments if necessary
• Researching and appealing denied claims.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• High school diploma or GED equivalent
• Minimum of 1 year of experience as a medical biller.

PROFESSIONAL COMPETENCIES

• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Knowledge on CPT, ICD-10-CM and HCPCS codes.
• Knowledge of coding principles and guidelines.
• Knowledge of billing principles and guidelines.
• Knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services.
• Excellent written and oral communication skills
• Fluent in English and Spanish

LICENSURES AND CERTIFICATIONS

• Prefer but not require American Academy of Professional Coder (AAPC) Certified Professional Coder (CPC) or American Health Information Management Association (AHIMA) Certified Coding Specialist (CCS).

WORK ENVIRONMENT

• The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
• Travel may be required.

We’re Making Healthcare Right. Together.

We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:

Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.

Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.

Powered by Technology

We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.