SUMMARY: Knowledgeable in Medicare, Medicaid, Worker’s Compensation and Third Party Payer claim processing. Knowledgeable in bookkeeping, computer skills as related to claims processing, possess organizational skills and the ability to work independently.

ESSENTIAL DUTIES AND RESPONSIBILITIES: (as assigned) 

• Demonstrates knowledge and ability to follow medical billing practices.
• Demonstrates knowledge of Medicare, Medicaid, Insurance Managed Care Plans and Workmen’s Compensation.
• Manages Accounts Receivable effectively, reviewing with manager problem claims.
• Reads and monitors bulletins from plans subscribed to for changes and updates in claims submission.
• Follow up phone calls on collections.
• Gives professional customer service to patients and public at all times.
• Maintains any logs necessary for collections and QA purposes.
• Download Medicare receipts on accounts.
• Submits all claims to Medicare, Medicaid, primary insurances, and supplemental/secondary insurances.
• Enter charges for services rendered.
• Re-submits claims as necessary and handles appeals process when necessary.
• Researches and resolves correspondence from insurance carriers or private patients concerning claims.
• Reviews and corrects claim edits and denials to ensure proper payment for services rendered.
• Develops and maintains positive, effective working relationships with other employees, supervisors and medical providers.
• Ensure strict confidentiality of financial and medical records under HIPAA, HIPAA Security laws and hospital/clinic policies and procedures.
• Communicates clearly written and oral medical information to professional practitioners and/or the general public.
• Attends meetings as required.
• Miscellaneous duties as assigned requested or required.

QUALIFICATIONS:

• Communicates in an effective manner, follow written or verbal instructions and demonstrates good interpersonal skills to deal with team members, patients and families.
• Knowledge of insurance policies.
• Competent with the accounts receivable accounting system.
• Competent in Microsoft Office Word and Excel.
• Maintain discretion and confidentiality in communications.
• Familiar with policies and procedures regarding reporting and release of protected health information (PHI).

EDUCATION and/or EXPERIENCE:

• High School Diploma/GED
• 1 year experience in bookkeeping, clerical and applicable computer training
• Ability to be a quick learner; works well with little supervision and works well with teams
• Prior hospital, physician office and/or medical coding, preferred
• Meditech Electronic Health Records Experience, preferred

LANGUAGE/READING SKILLS:

• Communicate verbally and in writing in English.

MATHEMATICAL SKILLS:

• Must be proficient at mathematical and statistical calculations.

REASONING ABILITY: Employee responds to unusual or varied situations that are not covered by existing standards, procedures and precedents. 

WORK ENVIRONMENT: Employee is regularly required to stand, walk, sit, ascend and descend stairs, possess ability to handle, finger or feel objects, tools or controls; reach with hands and arms. 

Employee must frequently be able to lift 25 pounds from the floor to waist level. Specific vision abilities include close vision and the ability to clearly focus vision.