POSITION: Medical Biller (JB52)

The Medical Biller is responsible for working directly with patients, payers, prescribers, and other clinical and administrative staff to ensure the proper billing and reimbursement of services performed. The associate will also collaborate on care coordination for infusion patients.

The Medical Biller is knowledgeable of payer requirements, pharmacy and medical benefits, prior approval processes, medical necessity requirements, claims submission, account monitoring, and current legislation pertaining to patient rights and billing standards. Regular review and consideration must be taken to stay current with HCPCS, diagnostic coding, and modifiers. The individual will need to work with clinical staff members and other individuals as it relates to care coordination for infusion services. S/he will assist in developing and maintaining current billing processes pertaining to both patients and payers. This individual will also work regularly with entities such as the clearing house for accounts receivable. The Medical Biller reports to the Multi-Site Practice Manager, Ambulatory Services.

Primary responsibilities are:

• Collect, review, and interpret external data sets that support sales opportunities
• Conduct a thorough investigation of patients’ benefits
• Satisfy any prior approval processes
• Collection of funds
• Conduct coding for billable services
• Submission of claims and claims monitoring
• Collaborating with the clearing house on claim edits
• Claims and patient payment posting
• Knowledge of EMR systems, healthcare compliance, and related legislation is a must.

 
Additional responsibilities include:

• Establishing and maintaining relationships with third parties such as vendors and payers
• Coordinating care with all parties involved
• Working on any denials or claims’ requests such as appeals, resubmissions, or additional documentation requests
• Back up to Front desk/administration assistance

Competencies:

• Key advocate for patient education on benefits, approvals, and any cost shares expected.
• Knowledge of EMR systems, healthcare compliance, and related legislation is a must.
• Outstanding verbal and written communication skills as they will be a key contact point for the company.
• High level of technical savvy across multiple platforms such as Windows, Microsoft Office Suite, and healthcare-related software.
• Ability to maintain and adhere to a strict level of confidentiality, demonstrate outstanding judgment, and be able to manage multiple tasks or projects simultaneously.

 
Supervisory Responsibilities 

Directly supervises employees in the Infusion Department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Minimum Qualifications

A College degree and at least two years’ medical coding, billing, and reconciliation experience in the healthcare industry is required. Related experience in collections, finance, patient care, and communications, or similar qualifications are highly desirable. Must have the ability to work effectively within all levels of the organization, from executives to individual contributors. Strong project management and cross-functional team collaboration skills with a demonstrated ability to plan and drive results and achieve deadlines (especially pertaining to diligently working within Timely Filing Constraints) are key.

Work Environment

The Medical Biller thrives in a faced-paced work environment. Must be able to sit for prolonged periods of time at a desk and perform work on a computer in an office environment. Light to moderate lifting may be required at times. Reasonable accommodations can be made to enable individuals with disabilities to perform the essential job functions. The position is based at our Headquarters location here in Kalamazoo, MI.

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OptiMed Health Partners, headquartered in Kalamazoo, Michigan, is a rapidly growing healthcare company that is an independently owned and operated national specialty pharmacy and infusion provider. We are focused on developing outstanding integrated solutions for patients, employers, providers, payors, and pharma. We help connect people to improved care. With over 25 years of experience, we’re committed to taking a different approach by focusing on small details to create customized solutions that enhance quality, minimize costs, and maximize patient outcomes. As industry leaders, we are equipped to change the way healthcare is experienced. We keep patient outcomes at the heart of everything we do in order to build a unified, value-based partnership with healthcare providers, payers, manufacturers, and health systems. We select our partners carefully with the same vision in mind to usher in a new standard of excellence.