Billing/Accounts Receivable Clerk

POSITION: Billing and Accounts Receivable Clerk

DEPARTMENT: Front Office

REPORTS TO: Front Office Supervisor

Job Summary: This individual is primarily responsible for claims submission and denial management, reviews accounts receivable to determine necessary action to be taken for reconciliation of claims.

Education and Experience:

1. High school diploma or equivalent.

2. Two years minimum experience in medical office; billing and collections experience preferred.

3. Strong computer background.

Essential Skills and Abilities:

1. Excellent communication skills, written and oral.

2. Strong organizational skills with attention to detail.

3. Strong computer literacy and spreadsheet experience.

4. Strong mathematical and problem-solving skills.

5. Working knowledge of medical billing software.

6. Working knowledge of standard accounting principles and budgetary experience.

7. Knowledge of Medicare/Medicaid and private insurance rules and regulations, CPT, and ICD-9 & 10 coding.

8. Management of multiple tasks simultaneously.

9. Excellent follow-up skills.

10. Ability to work as a team player.

11. Ability to treat patients and co-workers with respect.

Primary Responsibilities:

1. Claim Submission

“Pre-scrub” claims to minimize rejections or issues at clearinghouse.

· Ensure claim correctness and inclusion of all necessary details; patient name, policy, authorization, etc.

· Ensure claim correctness in linking procedure codes and diagnosis codes used – change these as needed as per specific insurer guidelines when appropriate.

Submit claims to clearinghouse daily and check their status throughout the day.

Identify rejections at clearinghouse and determine what needs to be corrected to resend.

Research and analysis of missing tickets (aka “superbills” or “chargeslips”).

2. Claims Denial Management

Receives notice or copies of denied claims that require appeal.

Determine reason(s) for denied claim and promptly submit appeal to avoid exceeding appeal timelines.

Submits requested, required (or sometimes necessary) information – by phone, fax, or other method - to render a successful appeal. This information may include patient plan details, medical records, insurance guidelines, etc. Works with other billing personnel to maximize successful appeal results.

3. Accounts Receivable

Generates monthly AR report for all accounts 60 days and over - for all pay classes.

Calls those patient accounts which are 60 days past due.

Encourages and establishes possible payment plans if/when appropriate and agreeable.

Maintains daily log of patients from whom the practice is expecting payment; follows-up on non-payments.

Works with supervisor to determine which accounts over 90 days need additional follow-up, tracer letter, or other action (ex: write-off or send to doctor for additional advice).

Pulls copies of insurance claim forms from the tickler file (or other filing system) each morning; checks each claim through the system to determine whether the claim has been paid; sends additional tracer letter, or other action for claims not paid. Makes appropriate notes on the analysis report and in the system when replies are received on the tracers and takes necessary steps, i.e., account balances are transferred from insurance to patient when appropriate.

Monitors the results of previous letters or actions; sends additional letters or places additional call if no activity has resulted within 15 days.

Meets with the supervisor of the accounts receivable department weekly to discuss problem accounts and plans for upcoming week.

Monitors daily appointment schedules to become aware of scheduled patients with any open balances.

Takes calls directed to the accounts receivable department from patients and/or insurance carriers. Discusses accounts with patients and provides whatever information is required by insurance companies in order to get claim paid.

Reviews the accounts on the AR Aging Report monthly to determine the accounts requiring immediate attention (over 60 days and over $100 balance are priority).

4. Statements

a. Reviews list of pending statements to go out – ensuring first that the balance ispatient financial responsibility. Otherwise, proceed with appropriate re-direction of claim.

b. Generate and process monthly statements and ensure their delivery.

c. Changes addresses in the system on returned mail and resends.

Other Responsibilities:

a. Assists other front office personnel with overflow of incoming calls.

b. Backs-up check-in and check-out personnel as needed.

Performs other duties, as required.

Job Type: Full-time

Pay: $15.00 - $19.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Life insurance
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: In person

Salary : $15 - $19