Req Number 001F94
Job Category Billing Clerical
Provides accurate and complete patient information, secures prompt adjudication for services provided by the institution and maintains the highest quality of service for our customers. Applies knowledge of federal and state regulations, departmental policies and procedures and sensitivity to the needs of patients and their families.
Communicates with appropriate third party insurance carriers in order to obtain payment on outstanding balances and ensures claims are adjudicated on a timely basis. Utilizes several types of media (i.e. Omnipro, SMS reports, MEDE, AccuClaim,) by telephone, fax or mail.
Obtains and/or verifies patient/guarantor demographic, insurance, and charge data, ensures information is complete and valid by use of several types of media (i.e. Omnipro, SMS reports, MEDE, AccuClaim,) and communicates with patients, guarantors, and/or insurance carriers either by telephone, fax or mail to resolve any discrepancies that may be delaying the adjudication of claims.
Updates patient records with accurate information on SMS system. Requests rebills on claims when necessary. Utilizes the SMS patient accounts system to request claims for processing to carrier and ensures accurate information is being billed to patients/third party carriers.
Responds to insurance companies’ inquiries, sorting by order of information requested in order to provide required data.
Requests medical records from the Medical Records department by use of the Copyright System in order to provide insurance carriers with the medical information required by them to determine medical necessity.
Reconciles patient accounts upon receipt of payment from insurance carriers. Reviews explanation of benefits received from carriers and adjusts accounts according to contracted rates in order to maintain correct accounts receivable.
Prepares refunds for patients and insurance companies by copying explanation of benefits and completing check request forms in order provide control clerks with the necessary documentation required for issuing appropriate refunds.
Completes productivity log by recording the number of patient accounts processed each day, including activity and dollar amount in order to monitor the effectiveness of follow-up efforts.
Assists in the training of new patient representatives by explaining written policies and procedures in order to acclimate the new employee to the institution.
Performs related duties, as required.
*ADA Essential Functions
· High School Diploma or equivalent, required. Some college preferred.
· Minimum two (2) years businesses experience, preferably in the health care field, required.
· Computer literacy including knowledge of Microsoft Word and Excel, required.
· Knowledge of Shared Medical Systems (SMS), preferred.
· Strong verbal and written communication skills, highly motivated, detail-oriented and