Accounting Technician (Medical Biller) [GLOC]
Competency-based
ONET: 43-3303.10
1
Years
58
Skills
288h
Related instructions
Classroom instruction topics
- Onboarding
- Orientation
- CPB Medical Billing Course
- Medical Terminology Course
- Documentation for Rehabilitation Professionals
- Emergency Care - Insured or Not
- Medicaid in the Quality Payment Program
- Medicare Advantage and Other Medicare Plans Resources
- Medicare and Medicaid Fraud Abuse and Prevention
- Medicare Parts C and D; General Compliance Training
- Utilization Management
- Value Based Purchasing
- The Merit-based incentive Payment System
- Core Required Courses for Billing Staff
- Nextgen System Training
- Athena System Training
- Insurance Card Training
- BCBSM Claims Training
- BCBSM Coding and Documentation
- BCBSM Prior Authorization
- BCBSM Provider Fundamentals
- WPS Medicare Training
- Medicare A/B DME Collaborative Medical Documentation
- Third Party Payer Day
- Prior Authorization of Orthoses
- Life Cycle of A Claim
- Customer Service Training
- Computer Skills for the Workplace
On-the-job training
- OJT/Task/Competency
- Obtain referrals and pre-authorizations as required for procedures and office visits
- Review documentation for medical necessity based on payer criteria
- Check eligibility and benefits verification for treatments and procedures
- Review accuracy of insurance information loaded by front desk/pre-registration staff
- Prepare cost estimates for upcoming procedures
- Demonstrate basic understanding of CPT, ICD-10 and HCPCS codes
- Review patients bill for accuracy and completeness, and obtain and missing information
- Prepare, review and transmit claims using billing software, including electronic and paper claim
- Follow up on unpaid claims within standard billing cycle timeframe
- Check each insurance payment for accuracy and compliance with contract discount
- Call insurance companies regarding any discrepancy in payment if necessary
- Identify and bill secondary or tertiary insurances
- Review counts for insurance and patient follow-up
- Research and appeal denied claims
- Answer all patient or insurance telephone or email inquiries pertaining to assigned accounts
- Answer staff questions regarding coverage/cost for various service
- Update billing software with fee schedule, reimbursement and RVU charges
- Update CPT, ICD-10 and HCPCS yearly within billing software
- Update cash spreadsheet and run collection reports
- Maintain files within PM system for payers and ensure correct edits, claim process rules, etc. are applied
- Prepare and review various AR reports
- Apply Incident - To status to claims per payer rules
- Understand billing guidelines (modifier requirements, claim filing limit, order of priority, etc.) for government payers (Medicare, Medicaid, Tricare, VA, etc.)
- Understand billing guidelines (modifier requirements, claim filing limits, order of priority, etc.) for commercial payers (BCBX, Priority Health, Aetna, Cigna, United Healthcare)
- Understand billing guidelines (modifier requirements, claim filing limits, order of priority etc.) for worker's compensation and automobile accident (PIP)
- Understand overpayment/refund processes for various payers as well as how to post refunds/overpayment recoupment in system
- Access CAQH and other credentialing platforms for new providers and updates
- Collect various provider identifiers including NPI, Tax ID, PTAN, State License and DEA numbers for new providers
- Obtain and maintain access to various payer websites
- Use 3rd party software integration with PM system for payment plans, email payment reminders, etc. and understand how to coincide
- Process overdue patient accounts to bad debt/3rd party collection agency
- Participating Employer - Behavioral Competencies
- Participation in team discussions/meetings
- Focus in team discussions/meetings
- Focus during independent work
- Openness to new ideas and change
- Ability to deal with ambiguity by exploring, asking questions
- Knows when to ask for help
- Able to demonstrate effective group presentation skills
- Able to demonstrate effective one-on-one communication
- Maintains an acceptable attendance record
- Reports to work on time
- Completes assigned tasks on time
- Uses appropriate language
- Demonstrates respect for patients, co-workers and supervisors
- Demonstrates trust, honesty and integrity
- Requests and performs work assignments without prompting
- Appropriately cares for personal dress, grooming and hygiene
- Maintains a positive attitude
- Cooperates with and assists co-workers
- Follows instructions/directions
- Able to work under supervision
- Able to accept constructive feedback and criticism
- Able to follow safety rules
- Able to take care of equipment and workplace
- Able to keep work area neat and clean
- Able to meet supervisor's work standards
- Able to not let personal life interfere with work
- Adheres to work policies/rules/regulations
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