Billing Clerk

Department: Billing | Non-Exempt | Reports to: Billing Department Manager

About the Role

Responsible for ensuring maximum payment from insurance companies by reviewing explanation of benefits and following up with appeals as needed. Accountable for compliance with regulations mandated by governmental agencies and Policies and Procedures established by the Board of Directors of SMSC.

Responsibilities

• Process tasks, accounts receivable, and appeals within specified timelines:
  • Complete 100% of tasks within 48 hours of receipt for proper reimbursement and/or appeal write-back.
  • Research accounts for accuracy with 100% follow-up maintained on a timely basis.
  • Work all unpaid balances and credits on a monthly basis.
  • Complete appeals requiring no research within 48 hours; those requiring research within 96 hours.
  • Enter comments and pertinent information into the computer at the time of receipt, maintaining 100% accuracy.
• Locking and billing Privia tickets, and working Privia tasks.
• Provide customer service and perform other duties or special projects as assigned:
  • Attend seminars and workshops, and stay current on billing issues and changes.
  • Treat others politely and with respect, maintaining professionalism and consideration for patient needs.
  • Respond concisely and accurately to questions, ensuring patient expectations are met.
  • Demonstrate responsiveness and a willingness to help patients, providers, and co-workers.

Requirements

• High School Diploma or equivalent.
• Computer proficiency with the ability to type 35 WPM.
• General knowledge of billing department functions, with a focus on claims reimbursement and filing procedures.
• Knowledge of Medicaid claim reimbursement and filing procedures, and government rules for Medicaid (a plus).
• Knowledge of ICD-10 and CPT codes (a plus).
• Detail-oriented with the ability to work independently and meet deadlines.
• Willingness to travel to out-of-town meetings, workshops, and seminars.
• Strong communication skills to interact positively with billing company representatives, governmental agencies, patients, and co-workers.
• Ability to maintain a professional demeanor, sit for extended periods using a computer and telephone, and maintain regular attendance.
• Ability to think rationally, reason logically, and maintain absolute confidentiality.

Working Conditions

• Office environment with a fast pace.
• Frequent telephone contact with insurance companies.
• Access to email, web surfing, time card, work order tracking system, and interoffice instant messaging.
• Full access to patient billing and financial data; limited access to medical data (templates, documents, and scanned information pertinent to job duties).
• Limited ability to add information to patient charts; no ability to modify or delete data entered by others.
• May have access to view and print patient data in Orchard Harvest and PACS, as provided by Lab/X-ray department managers, as needed for job function.