Billing Clerk

QUALIFICATIONS

High school diploma. One or more years of experience in working insurance denials for effective resolution. Experience working with Electronic Medical Records. Two or more years in medical billing and collections. One or more years in State Contract Service Environment. One or more years working with DD billing. Functional knowledge of computer and Microsoft Office.

ASSIGNED DUTIES

Duties include, but are not limited to:

• Entering and process all billing data for Developmental Disability Participants
  • Calculates data and completes monthly reports of DD services for CEO and State required reports.
  • Tracks Authorizations and notifies by email appropriate staff when any consumers authorizations are going to expire (30 days ahead of expiration) and if units are depleted and new authorizations are needed.
  • Works with managers and supervisors to assist with all billing and authorization problems and reaches a resolution in a timely manner
  • Shares responsibility of downloading and filing all insurance on Wednesday of each week and not later than Friday of each week and posting of payments.
  • Communicates with insurance providers to reach resolutions for billing issues and reports to appropriate staff and CIMO of all issues that will cause a claim rejection, billing, coding and use of modifier issues and errors.
  • Works insurance denials to reach resolution within 5 days from the date the RA is received. Alerts appropriate staff of needed changes or corrections and follows through to ensure claim is resubmitted within in the time limits for each insurance provider.
  • Work with DD managers and supervisors to assist with all billing and authorization problems and reaches a resolution in a timely manner. Notify immediate supervisor if problems are not resolved within 5 days

• Entering and process all billing data for non-DD claims:
  • Extract, enter, works insurance denials to reach resolution within 5 days from the date the RA is received. Alerts appropriate staff of needed changes or corrections, and follows through to ensure claims is resubmitted within the time limits for each insurance provider.
  • Work with managers and supervisors to assist with all billing and authorization problems, and reaches a resolution in a timely manner. Notify immediate supervisor if problems are not resolved within 5 days.

• Medical Records Support
  • Provides support to the Medical Records Department by releasing medical information in either oral or written format. Obtaining necessary releases from Individuals, following HIPAA regulations, to allow for the release of such medical information.

• Provides on-going/on-call operational and end-user assistance:
  • Analyzes and resolved problems on a local level in an accurate and timely manner.
  • Answers calls from local administrators and/or users in a timely, efficient, and professional manner
  • Document problems and resolutions within agency support system
  • Treats all end users with respect and courtesy.
  • Listens to end-users and maintain a professional business relationship