Insurance Billing Clerk

JOB SUMMARY

Under the direct supervision of the Manager of Patient Financial Services, this position is primarily responsible for all processes necessary to submit claims to insurance companies for hospital services.  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

1. Process new claims daily in billing software for submission to Third Party Insurance Carriers to include Primary, Secondary and Tertiary claims. 
2. Demonstrates the ability to determine correctness of charges and coding.
3. Secure needed medical record documentation required by or requested by insurance companies when necessary to submit with claims.
4. Work Account checks in Expanse to allow accounts to accurately produce claims.
5. Use of critical thinking to ensure accurate and timely submission of claims.
6. Work with other departments regarding coding or charge issues related to claims.
7. Processes late charges on a daily basis and resubmits those charges to the insurance carriers.
8. Process accounts that meet the combined accounts rules by payer to ensure timely billing of those accounts.
9. Assist with Aging Accounts Receivable after processing of new claims in the AR bucket of 61-90 days
10. Attend or participate in webinars/seminars concerning billing and reimbursement changes.
11. Work with patients when needed to obtain resolution of accounts.
12. Must be able to work effectively with others and complete tasks within specified or given deadlines.
13. Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.

DEPARTMENTAL AND ADDITIONAL JOB RESPONSIBILITIES

1. Any addition responsibilities as requested or assigned by the Manager of Patient Financial Services or the Director of Revenue Cycle.
2. Maintain strict confidentiality related to all Memorial Healthcare data and information as dictated by hospital standards, policies, and procedures.
3. Access Memorial Healthcare systems and information only as necessary to perform job duties.

JOB SPECIFICATIONS

EDUCATION

1. High school diploma or equivalent is required.
2. Post high school courses in medical billing, medical terminology is preferred,
3. Word and Excel experience is preferred.

EXPERIENCE

1. A minimum of one - two year experience with automated billing system either in a hospital and/or physician setting is preferred.

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.

1. 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.
2. 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.
3. 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.
4. Speaking/Hearing:  Ability to give and receive information through speaking and listening.

ESSENTIAL TECHNICAL ABILITIES

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

ESSENTIAL MENTAL ABILITIES

1. 1. 1. Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.
      2. Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws
      3. Attention to detail.

ESSENTIAL SENSORY REQUIREMENTS

1. Able to see for the purpose of reading information received in formats including, but not limited, to paper, computer, reports, bulletins, updates, manuals.
2. Able to see and hear for work-related purpose.

INTERPERSONAL SKILLS

1. 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.
2. Required to remain calm when adversity is encountered.
3. Open, honest, and tactful communication skills.
4. Ability to work as a team member in all activities.
5. Positive, cooperative and motivated attitude.