The Claims Billing Clerk will process and follow up on all claims for the following payers – Medicare, Medicare Managed, Medicaid, Medicaid Managed, Commercial Insurance, Liability and Workers Compensation for both hospital (inpatient and outpatient) and rural health clinic services

Duties/Responsibilities:

• Reviews, corrects and electronic transmits all claims that drop into our claim product from the AR system.

• Review and post electronic remits for Medicare on our AR system.

• Reviews Medicaid remits prior to scheduled payment date for applicable corrections .

• Reviews EOB’s from all payers when reimbursement is not provided and resolves all issues.

• Submits requests for account adjustments / corrections to the Director of Patient Accounts.

• Reviews aging report to resolve credits or outstanding balances.

• Maintains the required spreadsheets for Medicare (traditional and Managed) and for Medicaid (traditional and Managed)

• Performs other related duties as assigned.

• Adheres to the facility’s Standards of Excellence.

Required Skills/Abilities: 

• Must have good verbal and written communication skills to discuss billing with medical staff, HIM, patients, and Collection department.

• Must have good problem solving skills and attention to detail

• Must have good analytical and organizational skills

Education and Experience:

• High school diploma or equivalent required.

• One to two years’ experience with processing a high volume of claims.

Physical Requirements: 

• Prolonged periods of sitting at a desk and working on a computer.

• Must be able to lift up to 15 pounds at times.