Medical Billing Clerk

Job Title: 411

Location: Odessa

Supervises: N

FLSA: Non-Exempt

Division: ADM

Salary:  $15.66 per hour.  Sign on bonus may be available.

Shift: M-F 8am - 5pm; Assigned work hours may change as the needs of the agency and clients change

Driving required: Y

Travel required: Y

Settings: office

POSITION SUMMARY/JOB PURPOSE:

The Medical Billing Clerk reconciles payments received from third party payers with the Accounting Deposit Log, assists staff to maximize third party billings, and processes and sends monthly statements to clients.  This position investigates and resolves differences revealed from payment reconciliation and identifies problems within the third party billing for accurate coding, etc.

This position works independently, under limited supervision, reporting major activities through periodic meetings.

EDUCATION, EXPERIENCE, OTHER QUALIFICATIONS:

Education Required:  High School Diploma or GED.

Experience Required:  At least 1 year experience in medical office as third party biller preferred.

Registration, Certification, Licensure or other Qualifications Required: 

• Must maintain a valid Texas Driver's license, auto liability insurance and a driving record acceptable to PermiaCare's insurance requirements.
• Required to pass criminal history and background checks as well as pre-employment drug screen.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Download all third party 835 payment files and EOB pdfs in the billing drive.
• Download third party DPP 835 payment files in the DPP payment folder to allow processing by DPP Payment Processing folder.  Upload all 835 files including DPP 835 files in EHR for overnight processing.
• Post paper EOBs from third party payers as they are received.
• Reconcile third party payments to Accounting deposit log.
• Analyze DPP payments amounts for accuracy.
• Work ER claim file rejections and/or unposted 835 claims in EHR.
• Analyze and oversee all claim denials, rejections and requests for more information from third party payers.
• Analyze and work denied claims on Claim MD and correct and reprocess and/or refile for corrected payment.
• Process and mail client statements along with the Insurance Verification Specialist monthly.
• Respond to phone calls related to client statements, analyzing services that are being billed to the client as well as the insurance company.
• Work with other clerks to correct claim denials or rejections due to client coverage or eligibility issues, and resubmit for payment.
• Receive payment requests from IDD providers which pertain to HCS billing for AA, DE, MHM.
• Meet unit performance measures or targets.
• Enter accurate and appropriate documentation of services within timeframe required.
• Maintain confidentiality of sensitive records and treatment information, client files and protected health information in compliance with HIPAA, laws, rules and regulations, and established procedures.
• Maintain regular and reliable physical on-site attendance. Regular attendance, dependability, and promptness are required for the scheduled work day 100% of the time, to ensure consistency and completeness of program's processes.
• Comply with the Abuse, Neglect, and Exploitation policy and reporting requirements.
• Adhere to the Code of Conduct and Standards of Behavior policy requirements.
• Establish and maintain effective work relationships with individuals served and their families, supervisors, co-workers and visitors by demonstrating cooperative, courteous and respectful behavior at all times.
• Communicate regularly with supervisor.
• Open and process mail/email in a timely manner.
• Answer phone, collect phone messages and respond to requests timely and accurately.
• Maintain safe and clean working environment by complying with procedures, rules and regulations.
• Perform all work functions and interactions using a trauma informed approach.
• Display professionalism when representing PermiaCare and the program in the community.
• Maintain compliance with legal requirements and company policies and procedures.
• Maintain valid and current driver's license, auto insurance, acceptable driving record and reliable transportation at all times. Driving may be required for this position.
• Complete all training as assigned prior to due date.
• Other duties as assigned.

MARGINAL DUTIES AND RESPONSIBILITIES (these duties are not designated as essential for the purposes of ADA; they are still required duties):

• Fill in for other clerical staff as needed.
• Assist financial clerks with claim denials or rejections of claims related to client eligibility issues as needed.
• Collect client credit card payments.
• Answer any questions clients may have about their statements and correct issues if needed in the EHR.
• Upload or assist supervisor with third party claim submission into Claims Clearinghouse.
• Assist Reimbursement Supervisor with provider credentialling.
• Provide translation, if applicable.
• Participate in team meeting or staffings.
• Participate in community activities and/or attends community meetings as needed.
• Participate in workgroups and committees as assigned.

KNOWLEDGE, SKILLS, ABILITIES AND COMPETENCIES:

• Knowledge of spreadsheet formulas and data entry.
• Ability to accurately perform detailed reconciliation.
• Ability to investigate and resolve differences discovered during the reconciliation process.
• Ability to analyze client statements for discrepancies.
• Knowledge of EHR billing software.
• Knowledge of various insurance company portals.
• Ability to audit DPP payments.
• Knowledge of HIPAA and ability to protect confidentiality.
• Effective multi-tasking skills.
• Good organizational skills.
• Welcoming, positive behavior.
• Ability to express self clearly and effectively, orally and in writing.
• Effective time management skills.
• Exceptional customer service skills, including positive attitude.
• Cultural sensitivity.
• Dependable attendance and punctuality.
• Knowledge of trauma informed theories, principles and practices.
• Flexibility and adaptability to different work environments.
• Excellent computer skills, including Word, Excel, Outlook, and Electronic Health Records (EHR).
• Reading and comprehending.
• Reasoning and analyzing.
• Ability to coordinate with various inter-agency personnel.
• Ability to fulfill PMAB and CPR/First Aid requirements.
• Ability to work independently.
• Good interpersonal skills, including ability to build rapport with individuals including co-workers.
• Ability to display comfort in interacting with individuals of diverse cultural, ethnic and economic backgrounds and with social service, healthcare, educational and criminal justice organizations, as needed.
• Ability to acquire and utilize new skills as the job requires.
• Ability to work cooperatively and productively with supervisor, individuals, co-workers, and groups of persons at all levels of activity, contributing to a spirit of teamwork.
• Ability to maintain highly confidential information.
• Ability to remain calm in stressful situations.
• Ability to plan and schedule work and implement directives without constant supervision.
• Model professionalism by appropriate dress, language, ethics and work habits.
• Ability to drive personal and/or company vehicle.  This position may require travel to agency program sites, community and residential sites, and/or locations outside the PermiaCare catchment area.  This position may require transport of agency individuals and/or individuals served.

PHYSICAL REQUIREMENTS:

Abilities Required:

• Light Lifting, under 15 lbs
• Light Carrying, under 15 lbs
• Walking
• Standing
• Sitting
• Operating office equipment
• Operating motor vehicle
• Ability to see
• Hearing (with aid)
• Ability to write
• Ability to count
• Ability to read
• Ability to tell time

Other (specify):  driving required. May require some travel after hours and overnight.

WORKSITE CONDITIONS:

• Travel
• Inside
• Working closely with others
• Working alone

ADA Statement:  Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

EEO Statement:  PermiaCare is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity Employer, making decisions without regard to race, color, ethnicity, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran status, genetic information, or any other characteristic protected by state or federal law.

This job description is not designed to cover or contain a comprehensive list of duties, activities or responsibilities that are required of the employee for this job.  Duties, activities and responsibilities may change or new ones may be assigned at any time with or without notice. This job description does not constitute an employment contract with PermiaCare.  Employment is at-will. 

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