Billing Clerk I, II, III

Department: Patient Accounting | Reports to: Business Office Manager | FLSA Status: Non-Exempt

Pay

• Billing Clerk I: $25.00 - $27.56 per hour
• Billing Clerk II: $27.00 - $29.77 per hour
• Billing Clerk III: $30.00 - $33.08 per hour

About the role

Under the direct supervision of the Business Office Manager, the Billing Clerk prepares and posts fee tickets for various sites and programs, balances payments received, handles incoming billing calls, works aging accounts for various programs and payers, sends patient statements, runs month-end reports, and submits third-party claims electronically or manually. The role ensures all providers and facilities are paneled with various insurances and state programs, maintains current knowledge of CPT, HCPC, and ICD-9 coding practices, and stays updated on program and payer source requirements and guidelines.

Responsibilities

Billing Clerk I

• Post daily fee tickets and/or incoming mail (charges, payments, adjustments) for various sites and programs electronically or manually.
• Review fee tickets for accuracy of diagnosis, CPT, and HCPC coding.
• Check for covered services per payer source to avoid claim denials.
• Run daily posting and transaction reports to balance total charges, payments, and adjustments.
• Check eligibility for third-party insurances.
• Run missing fee ticket reports to ensure all fee tickets have been posted or voided.
• Assist patients and employees with billing and insurance questions.
• Batch and balance third-party remittance advices (RAs) and distribute to billing clerks for correction when needed.
• Check CHDP claims for accuracy.
• Generate rebill and unbilled claims reports.
• Print and submit billing claims to all third-party insurances manually.
• Make necessary corrections to claims with errors.
• Adhere to safety policies and procedures, including infection control rules and regulations.
• Maintain HIPAA compliance, employee confidentiality, and privileged communications.
• Demonstrate cultural sensitivity and competence.

Billing Clerk II

• Cover Billing Clerk I duties when needed (e.g., vacation or sick leave).
• Balance daily cash reconciliation sheet to ensure all cash posted (via fee tickets, incoming mail, or electronic cash receipts) is balanced monthly.
• Prepare cash reconciliation Excel spreadsheet for finance monthly.
• Submit third-party claims electronically and/or manually.
• Check claims error reports and make necessary corrections for resubmissions.
• Train employees on various payers and programs.
• Work accounts receivable aging for third-party insurance, sliding fee, and private pay.
• Work denials from third-party remittance advice/explanations of benefits.
• Run various month-end reports to balance monthly billing activities.
• Adhere to safety policies and procedures, including infection control rules and regulations.
• Maintain HIPAA compliance, employee confidentiality, and privileged communications.
• Demonstrate cultural sensitivity and competence.

Billing Clerk III

• Cover Billing Clerk I and II duties when clerks are on vacation or out sick.
• Update and maintain NextGen EPM file maintenance, BBP, and libraries.
• Process EDI files for specialty services and work claims edits reports.
• Assist billing staff with coding, posting, and NextGen EPM questions.
• Update electronic billing format for Medi-Cal/Medicare.
• Ensure specialty services (inpatient and surgeries) and modifiers are coded correctly to receive allowed reimbursement with no reductions.
• Adhere to safety policies and procedures, including infection control rules and regulations.
• Maintain HIPAA compliance, employee confidentiality, and privileged communications.
• Demonstrate cultural sensitivity and competence.

Requirements

Billing Clerk I

• High school diploma or equivalent.
• Two years of experience in medical billing and collections.
• Ability to establish and maintain effective working relationships with internal and external customers.
• Strong organizational skills.
• Computer literacy, including experience with word processing, spreadsheets, email, and keyboarding.
• Proficiency in Microsoft Office and Google Suite.

Billing Clerk II

• Same as Billing Clerk I, plus:
• Experience with billing of inpatient services, procedures, and surgeries.
• Knowledge of all billing modifiers and CPT, ICD-9, and HCPC specialty coding.

Billing Clerk III

• Same as Billing Clerk II, plus:
• Experience with report generation.
• Experience working all payer source aging reports.
• Ability to assist with new staff training.
• Experience setting up or updating NextGen practice management system with new providers, insurance information, and system master files.
• Experience paneling providers with various insurance companies.
• Experience transmitting claims electronically to various payers.

Skills

• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to write routine reports and correspondence.
• Ability to speak effectively before groups of customers or employees.
• Bilingual in English and another language is preferred but not required.
• Strong mathematical skills, including the ability to add, subtract, multiply, and divide in all units of measure using whole numbers, common fractions, and decimals.
• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
• Ability to apply common-sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Ability to deal with problems involving several concrete variables in standardized situations.

Certificates, Licenses, Registrations

• Current, valid, unrestricted California Driver’s License (Class C).

Other Requirements

• Pass a criminal history background check and drug screen upon hire.
• Annual health examination, including:
• Annual Tuberculosis skin test clearance or chest x-ray.
• Proof of immunity to MMR, Varicella, and Hepatitis B.
• Proof of Tdap vaccine.
• During flu season, proof of influenza vaccine or a signed declination form (if declined, a flu mask is mandatory).
• Health screening requirements are subject to change based on CDC recommendations and federal, state, and/or local public health ordinances.

Physical Demands

• Regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear.
• Frequently required to sit.
• Occasionally required to stand and walk.
• Must regularly lift and/or move up to 25 pounds.
• Specific vision abilities required include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Work Environment

• Frequently exposed to moving mechanical parts.
• Occasionally exposed to the risk of electrical shock.
• Moderate noise level in the work environment.
• Must be able to work in a fast-paced environment.
• Flexible work schedule may include evenings, weekends, and travel as needed.