JOB DESCRIPTION:  The Billing Clerk is a principal support position within the Fiscal Department.  The Billing Clerk networks with insurance companies with regard to authorizations, Outpatient Treatment Reports (OTR’s) and has proficiency with claims, aging reports, Medicaid rules and regulations, and must review and understand Explanation of Benefits forms received from insurance companies.  The Billing Clerk will perform tasks/duties as assigned which include but are not limited to detailed billing functions and fundamental mathematical calculations.

Full Time – 37.5 hours

$18.00/hour

SPECIFIC RESPONSIBILITIES INCLUDE:

• Responsible for the data entry of Daily Activity Sheets
• Responsible to print, review and mail patient bills
• Assist with client inquiries
• Review Medicaid Explanation of Benefits with pended and denied charges weekly and takes necessary actions to ensure that the charges are corrected and able to be re-billed in a timely manner
• Ensure that authorizations are maintained for all clients requiring authorizations in order for the insurance companies to pay the claims
• Ensure that OTR’s (Outpatient Treatment Reports) are completed and provided to the necessary insurance companies so that authorizations for services are in place prior to the clients receiving agency services
• Review aging reports by insurance companies; researches and corrects aged claims and meets the agency goal of having no claims on the aging report that are more than 60 days old
• Assist with reconciliation of LS3’s to the opens/closes within Simplemed for any given month
• Assist with other reporting reconciliations and billing issues as assigned
• Complete triage information sheet i.e.: responsible for obtaining all pertinent information with regard to patient demographics/health insurance/responsible party/chief complaint and complete data entry of this pertinent information into the clinic billing system
• Verify clients eligibility with specific insurance companies
• Verify that an appointment has been booked with appropriately credentialed provider and notify the specific billing clerk whose task it is to complete the insurance authorization that the client is ready for that process
• Verify insurance eligibility for the daily appointment schedules of all clinics
• Assist with the analysis and research of denied claims
• Maintain self in a professional manner at all times and adheres to The Neighborhood Center policy, procedures and the Agency Mission Statement.
• Perform other duties and tasks as assigned

REQUIRED QUALIFICATIONS:

• Ability/experience in performing billing analysis and reporting activities in detail
• Ability/experience in performing tasks accurately within a prescribed time frame
• Ability/experience in using common office record keeping and filing systems
• Ability/experience in understanding and applying regulations and procedures
• Ability/experience in communicating effectively and professionally with the general public and coworkers by various media
• Knowledge and experience with the operations of health insurance companies
• Experience with all aspects of health insurance eligibility verification both by telephone and through websites
• Experience entering information into computer demographic (client information) screens
• Organized and experienced in thorough follow-up of work tasks
• Experience in data entry and proven accuracy in data entry skills
• High School Diploma or Equivalency Diploma and four (4) years of experience in Medicaid and third party insurance billing and reconciliation.