Insurance Billing Clerk - Memorial Health Care Center

JOB SUMMARY

Submits claims to insurance companies for hospital services. Performs follow-up process with insurance company to obtain payment or proper processing of the claim to completion. Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.

PRIMARY JOB RESPONSIBILITIES:

Daily processes new claims for submission to Third Party Insurance Carriers – Primary, Secondary, and Tertiary claims. Able to determine correctness of charges and coding.

Secure needed medical documentation required by or requested by insurance companies.

Regularly compile Accounts Receivable (A/R) reports to be used in timely follow up of unpaid claims and to maintain the A/R at an appropriate level consistent with industry and department standards.

Regularly process mail received.

Regularly process posted batches/vouchers in order to follow up on rejections or partially paid claims.

Work with other departments regarding coding or charge issues related to claims.

Processes Late Charges on a daily basis and resubmits those charges to the insurance carriers.

When part of job responsibility based on insurance billing guidelines, will daily process Inpatient/outpatient account combination or outpatient/outpatient accounts and combine them according to billing guidelines.

When part of job responsibility based on insurance billing guidelines, will daily process accounts placed on hold during process described in #8 & 9 above to determine if hold can be released and account/claim billed out.

Keep updated on all billing and reimbursement changes regarding the insurance carriers the individual specialist bills for. Attend or participate in Webinars/seminars concerning billing and reimbursement changes.

Work with patients when needed to obtain resolution of accounts.

Must be able to work effectively with others and complete tasks within specified or given deadlines.

Any and all other duties as requested by the Patient Financial Services Manager or Director of Revenue Cycle.

JOB SPECIFICATIONS

EDUCATION: High School Diploma or equivalent required. Post High School courses in medical billing, medical terminology, Microsoft Word and Excel preferred.

EXPERIENCE: At least one year experience with automated billing system either in a hospital and/or physician setting desired.

ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS

These physical requirements are not exhaustive and additional job related physical requirements may be added on an as needed basis. Corrective devices may be used to meet physical requirements.

Sedentary Work: Frequently required to stand, kneel and crouch. On a daily basis may be required to move about, sit, climb stairs and bend. Is frequently required to lift and carry up to 20 lbs. May be required to push/pull/carry items between 20-100 lbs.

Vision: Requires the ability to perceive the nature of objects by the eye. Near

acuity: Clarity of vision at 20 inches or less. Midrange Acuity: Clarity of vision at distances of more than 20 inches and less than 20 feet.

Motor Coordination: While performing the duties of the job, it is required to regularly perform functions that include using hand and finger movement, handle or feel objects, be able to use tools or equipment that requires reaching with hands and arms. Must be able to travel independently throughout the hospital; access patients/families including areas confined by space and/or equipment.

Speaking/Hearing: Ability to give and receive information through speaking and listening.

ESSENTIAL TECHNICAL ABILITIES

Proficiency using modern office, computer and telephone equipment as used by Memorial Healthcare

ESSENTIAL MENTAL ABILITIES

Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.

Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws

Attention to detail

ESSENTIAL SENSORY REQUIREMENTS

Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.

Able to see and hear for work-related purpose

INTERPERSONAL SKILLS

Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication.

Required to remain calm when adversity is encountered.

Open, honest, and tactful communication skills.

Ability to work as a team member in all activities.

Positive, cooperative and motivated attitude

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