Title:  Pre-Bill Auditor/Biller II Job

Summary

Audits front-end data elements of a more complex, advanced, and non-routine level CPTs and/or ICD-10 codes relative to billing a clean claim.  Reviews demographics, insurance information, provider identification information, and charge capture documents and systems for accuracy and completeness.  Communicates findings to AR Supervisor to ensure applicable staff are made aware of pre-bill audit findings. Working under direct supervison of the AR Supervisor and Lead of the department to adhere to daily, weekly, monthly workflows, tasks, and assignments.  Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Education/Experience/Licensure

Knowledge/Skills/Abilities

• Thorough knowledge of insurance billing processes and procedures.
• Strong verbal and written communication skills.
• Ability to maintain good working relationships with co-workers and others external to the department.
• Strong knowledge all data elements compiled on standard billing forms/data sets.
• Knowledge of Practice Management Systems and basic computer skills.
• Detail oriented, excellent prioritization and organizational skills. 

Key Job Responsibilities

• Adhere to daily, weekly, monthly tasks and assignments to meet production standards of the department.
• Submits more complex, advanced, and non-routine claims to third party and governmental payers.
• Reviews PM system and output EDI “scrubber” output and corrects claims.
• Reviews output from payer level system edits and corrects claims.
• Documents “scrubber” findings and reports to leader.
• Assists Lead and Supervisor with training/orienting and providing guidance to lower level staff members.

Physical Requirements

• The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
• Must have good balance and coordination.
• The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
• The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
• The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.