Billing Clerk Job at Community Care of West Virginia, Inc.
Responsibilities and Essential Duties:
- Prepares and submits office-based provider claims to third-party insurance carriers either electronically or by hard copy billing.
- Posts all receipts from patients to proper patient accounts
- Secures the need for medical documentation required or requested by their party insurance companies.
- Process patient refunds and complete proper paperwork for payment of refund to either patient or insurance company.
- Follows up with third-party insurance carriers on unpaid claims until claims are paid, or only self-pay balance remains.
- Send patient accounts to a collection agency, if needed.
- Processes rejections by making accounts private, generating letters of rejection to patients, correcting any billing error, and resubmitting claims to third-party insurance carriers.
- Works with medical providers or medical record staff to ensure that correct diagnosis/procedures are reported to third-party insurance carriers.
- Regularly work with patient navigators to ensure correct patient/ insurance information is obtained.
- Makes accounts private and notify patients when claims have not been paid or rejected in established accounts receivable policy.
- Keeps updated on all billing and benefit changes for third-party insurance carriers.
- Posts third-party insurance remittance vouchers.
- Monitors claims for missing information, authorization/control numbers.
- Maintains confidentiality of all information.
- Completes work within authorized time to assure compliance with departmental standards.
- Keeps updated on third-party billing requirements and changes for insurance types within their area of responsibility.
- Demonstrates knowledge of, and supports, office mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
- Performs other duties as required
Teamwork:
- Assist in the orientation/training of new Team Members.
- Consistently work in a positive and cooperative manner with fellow Team Members.
- Assist other Team Members in the performance of their assignments.
- Seek out opportunities to help rather than waiting to be asked.
- Consider the impact of your actions on Team Members throughout the Organization.
- Recognize the need for variations in staffing and volunteer to fill open shifts when possible.
- Take direction and initiate actions (cross/additional training) to allow the assumption of cross-functional duties.
- Demonstrate flexibility to perform duties wherever volume deems it necessary within the organization.
Problem Solving:
- Demonstrate sound judgment by taking appropriate actions regarding questionable findings or concerns.
- Investigate and follow through on unusual orders or requests for service or information.
- Follow proper reporting procedures for actual or potential accidents and/or incidents so follow-up and/or prevention can occur.
- Record/report the need for service maintenance or repair of equipment and remove any faulty equipment from service.
- Consistently evaluate work and determine if further steps are needed to meet management expectations.
- Take the initiative to do or redo inadequate or incomplete work, even if it is not yours.
- Ensure compliance with regulatory standards.
Productivity/ Efficiency:
- Consistently demonstrate the ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.
- Minimize non-productive time and fill slow periods with activities that will enable you to prepare to meet the System's future needs (education, organizing, housekeeping, assisting others).
- Organize job functions and work areas to be able to complete varied assignments within established time frames effectively.
- Consistently demonstrate the ability to take the initiative to make decisions/choices without direct supervision.
- Demonstrate knowledge and understanding of all policies and procedures and the ability to reference them from appropriate books and manuals.
- Comply with CCWV's Exposure Control Plan, which reflects OSHA Bloodborne Pathogens Standard to ensure a safe working environment for self and others.
Physical Demands/Work Environment:
- Intermittent physical activity including walking, standing, sitting, lifting.
- Must be able to sit for long periods of time.
- Must have visual and hearing acuity within normal range.
- Must have manual dexterity needed to operate computer and office equipment.
- Will require the ability to lift heavy boxes up to 25 pounds in weight.
Qualifications/Requirements/Skills:
- Ability to bill third-party insurance for facility and professional claims by hard copy and electronically is preferred. Knowledge of third-party billing requirements is also preferred.
- Must show maturity in dealing with fellow employees and patients. Good verbal and written communication skills are essential.
- Knowledgeable of provider credentialing is a plus.
Experience
Preferred
- Successful completion of high school or commercial coursework, including math, bookkeeping, and business. Post-high school courses in insurance billing, data processing, and medical terminology are preferred.
- One year prior experience is preferred in the billing of third-party insurance for facility and professional services required. Must be able to type 35 wpm and operate a personal computer.
Education
Required- High School or better
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