Summary

This position is a full-time, goal-oriented, revenue-driven, highly accurate and motivated Health Claims Clerk.

Responsibilities

• Complete coding within a timely manner
• Communicate with patients, government agencies, and third-party payers to gather, process and record information.
• Possess strong customer service skills to communicate with departments and payers to optimize revenue based upon claim appeals for expected payer reimbursement.
• Work medical record billing report daily.
• Process, manage and follow up on claims to ensure timely resolution.
• Review both paid and unpaid claims, obtaining necessary information to follow up to resolve reimbursements.
• Assist in more complex claims as well as utilizing monthly aging reports to help obtain maximum reimbursement.
• Process medical records request in a timely manner.
• Send necessary appeals when warranted.
• Secondary duties include but are not limited to data entry of all patient demographic, guarantor, and insurance information, posting procedures and insurance/patient payments, balance to daily deposits, observe and comply with all HIPAA policies and procedures in accordance with PHI access level and immediately report any improper or questionable use and/or disclosures of PHI to the HIPAA compliance officer through appropriate channels.

Essential Functions

· Assign work; plan and manage priorities.

· Medical coding as assigned by Director.

· Resolve insurance claim rejections/denials, and non-payment of claims by payors.

· Identify trends in billing and follow-up, maintaining working knowledge of state and federal billing guidelines in order to identify ways in which our patients can expedite resolution of insurance accounts and identify delays in processing.

· Responsible for drafting effective appeals to insurance companies for reimbursement of monies owed.

· Responsible for maintaining daily account, follow-up work lists within department.

· Ensure compliance when processing claims, in accordance with contracts and policies; as well as to adjudicate claims as appropriate.

· Responsible for identifying, researching, and resolving credit balances, missing payments and unposted cash as it pertains to billing account follow-up.

· Process, and maintain within expectation, all correspondence received from patients and insurance companies as it pertains to correct and timely billing of claims, and receipt of payment.

• Responsible for handling patient disputes and submission of issues to coding for review to ensure organizational and revenue cycle processes are followed.
• Communicates appropriately with insurance companies, patients, co-workers and supervisors.
• Perform other duties as assigned.

Education and Experience Requirements

· Medical Coding Certificate required

· Medical Billing Certificate required

· Medical Terminology required

· Minimum of three years’ experience in medical billing and insurance account follow-up setting is required. Formal training or college coursework from a medical coding accredited school, specific to medical billing in lieu of experience may be considered

• Knowledge of insurance processes and billing guidelines regulations required.
• CPSI Billing Module experience preferred

Skill Requirements

• Proficient use of computers including Microsoft Office 2010 applications
• Skilled in 10-key by touch and keyboarding
• Ability to operate general office equipment
• Exceptional verbal and written communication skills
• Excellent attention to detail and ability to multi-task
• Ability to work with minimal supervision, independently, as well as in a collaborative team setting
• Strong organizational skills with the ability to prioritize and meet deadlines
• Requires knowledge of Commercial and/or Government Payors
• Ability to identify, research, and resolve credit balances, missing payments and un-posted cash as it pertains to billing account follow-up.

Physical Demands

· Intermittent periods of sitting and standing

· Lifting/carrying = 40lbs

· Periods of stooping/kneeling

· Occasional periods of high stress levels