CLINIC BILLING REPRESENTATIVE I

Title of Job: Clinic Billing Representative I
Status/FLSA Status: FT/Non-Exempt
Reports to: Business Office Director
Location: Mason District Hospital, Havana, IL
Date: March 2025

Primary Function:
Under the direct supervision of the Business Office Director, the Clinic Billing Representative I- is responsible for the credentialing of clinical providers. This role oversees the entire billing process, including completing necessary forms for billing all patient services, checking the patient registrations for accuracy, and analyzing patient charges.

The Clinic Billing Representative I is responsible for all Billing Office functions, working to facilitate the timely and accurate submission of all bills, which will support the hospital’s financial stability. This position utilizes the ICD-10, CPT, and HCPCS coding manuals and requires the ability to review and accurately code patient bills. This process also entails staying up-to-date with all Medicare and Medicaid billing regulations.

Responsibilities:

• Ensure timely and accurate credentialing of all clinic providers.
• Maintain provider credentials, licenses, and certifications, ensuring they are up-to-date and in compliance with regulatory and insurance requirements.
• Monitor and initiate the re-credentialing process to prevent lapses in provider billing eligibility.
• Generate, review, and verify billing reports for the previous day’s activities to ensure accuracy.
• Validate, update, and correct patient and insurance information as needed.
• Analyze patient charges and ensure proper documentation.
• Oversee all Billing Office functions to maintain efficient financial operations.
• Utilize ICD-10, CPT, and HCPC coding manuals to review and assign appropriate codes for patient services.
• Work closely with insurance companies to resolve billing issues and ensure prompt payment.
• Assist in identifying and correcting billing discrepancies to minimize claim denials.
• Accurately submit all completed claims to the clearinghouse for processing.
• Print and distribute billing forms when necessary.
• Prepare and submit monthly reports for the Business Office Director.
• Process and reconcile cash and insurance payments efficiently.
• Respond promptly and professionally to patient inquiries regarding patient billing and account statements.
• Maintain and update Medicare and Medicaid bad debt listings in compliance with regulations.
• Performs other related duties as assigned to meet the needs of the organization.

Qualifications:

• High school graduate or equivalent.
• Ability to communicate effectively, both verbally and in writing.
• Experience in medical billing, coding, or credentialing is preferred.
• Familiarity with ICD-10, CPT, and HCPC coding is preferred.
• Must be detail-oriented to accurately input patient information and verify insurance details to minimize errors.
• An ability to manage multiple tasks and responsibilities in a busy healthcare setting, demonstrating flexibility in handling changing demands.
• Must be capable of working with distressed or anxious patients compassionately and calmly, always maintaining professionalism.
• Familiarity with HIPAA regulations and healthcare privacy laws, ensuring compliance in all billing-related activities.

Physical Demands/Work Environment:
The physical demands and work environment described here are representative of those that an employee must meet to perform the essential functions of this job successfully.

The physical demands of this position include the ability to regularly sit, use hands and fingers, speak, and hear. This position requires limited standing, walking, reaching, and stooping/kneeling. Vision requirements for this position include close vision, including the ability to view text from a computer monitor.

The work environment for this position features a typical office setting with moderate temperatures and minimal noise, as well as limited physical risk.