The Tricare Biller/Collector is responsible for billing and collection on VA and Tricare claims at Midland Memorial Hospital. Required to prepare and submit accurate claims to the payer, tracking status of claim payment, and appealing any claim denials. Will identify denial trends and work collaboratively with various departments to develop prevention measures. Works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence. Knowledgeable of VA and Tricare regulations and to communicate any government updates and changes around billing and reimbursement practices.

SHIFT AND SCHEDULE

Full Time: 8:00 AM – 5:00 PM

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Prepare and submit claims to appropriate payer
• Track claim status through to payment
• Conduct internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations
• Maintain data on the type of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues
• Submit appeals on denied claims
• Regularly make complex decisions within the scope of the position, and is comfortable working independently
• Identify and resolve reimbursements and variance issues to resolve payment discrepancies (e.g., denials, underpayments, etc.),
• Work with various departments in the hospital to develop denial prevention measures.

EDUCATION AND EXPERIENCE

• High school diploma or equivalent required
• Demonstrated technical knowledge
• Analytic skills and the confident ability to make quick, effective decisions under pressure
• Strong organizational and prioritization skills.
• Strong oral and written communication skills.
• Must have acceptable keyboard and 10-key skills, along with strong knowledge of Word, Excel, Access, and other general computer expertise, or an equivalent combination of education and experience.
• 3+ years medical billing office experience preferred

PHYSICAL REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

• Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.