Billing Clerk

SUMMARY:

Responsible for audit of medical, dental, behavioral health claims for accuracy and timely electronic submission of claims through practice management system. Responsible for collections of outstanding claims and for maintaining accurate accounts receivable records in the organization's practice management system.

QUALIFICATIONS:

• High school graduate or equivalent.
• Three years' work experience in a medical office environment, to include work with Medicaid, Medicare, managed care organizations, and other third party payer claims submission and appeals.
• Federally Qualified Health Center (FQHC) experience preferred.
• Experience with medical and dental terminology, procedural and diagnostic coding (ICD, CPT, CDT, and HCPCS).
• Knowledge of all confidentiality requirements regarding patients and strict maintenance of proper confidentiality on all such information, maintaining compliance with HIPAA regulations.
• Good oral and written communication skills, proficient in answering billing questions
• Ability to deal professionally, courteously and efficiently with the public and all levels of the organization.
• Ability to handle multiple projects simultaneously.
• Ability to operate computer, copier, fax, and 10-key machine.
• Proficient in practice management system and Microsoft Office software applications.
• Basic accounting knowledge.

REQUIRED:

Bilingual in Spanish

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Preparation and timely submission of medical, dental, behavioral health claims.
• Application of insurance and other payments, and all adjustments required for accurate patient accounts receivable records.
• Responsible for collections of insurance and/or patient balances.
• Review insurance, patient account and request adjustment and/or refunds, as appropriate.
• Audit data entered in the practice management system for accuracy, and report discrepancies to the appropriate management staff.
• Responsible for monitoring the patient accounts receivable aging reports and using the reports to identify accounts requiring attention.
• Responsible for staying current with information needed for accurate claims submission to Medicaid, Medicare, CHIP and other third party payers.
• Responsible for staying current with the rules and regulations for all payers and the updates or changes in state and federal regulations, and notifying the appropriate health care services and management staff.
• Appeal and/or resubmit denied or rejected insurance claims.
• Responsible for setting up and maintaining the electronic claims submission software and running required reports.
• Work to resolve billing department errors and issues and inform billing manager of accounts receivable issues, and the potential effect the issues may have on the organization and reimbursements.
• Continually search for ways to improve the accounts receivable process, striving for efficiency in daily operations.
• All Health Center staff members have emergency and disaster response responsibilities. Participates in all safety programs which may include assignment to an emergency response team.