Correspondence & Insurance Claims Clerk

Job Title:                              Correspondence and Insurance Claims Clerk

Department:                      Payment Processing

Location:                             Texas

Reports To:                          Supervisor, Accounts Receivable

FLSA Status:                       Non-exempt

Summary of Position: 

The Correspondence and Insurance Claims Clerk is responsible for efficient, timely, processing of Requests for Information (RFI), etc. and ensuring that all activity dealing with correspondence has been documented.  As well as a final review and mailing of paper insurance claims on a timely basis as outlined in procedures for the processing of primary, secondary, Workers’ comp and rebilled claims. The CICC will provide clerical support to the Credit Balance Department and will be the back up to the Front Desk Position.

Job Responsibilities:

• Employee must adhere to STRG Policies and Procedures at all times
• Prepare and mail out paper claims to appropriate payers
• Post all assigned correspondence into the practice management system accurately and in a timely manner

• Input denial codes on accounts, taking adjustments when appropriate.  Enter notes on patient accounts.  Transfer to supervisor if necessary
• Process RFIs by mailing, faxing, etc. as indicated on the request each day.  Report to supervisor any requests received that do no allow enough time to respond by deadline on letter
• Handle Waystar appeals by reviewing claims, preparing necessary documents and submitting appeals for Coordination of Benefits
• Pull Remittance Advices (RAs) and reconcile them with the practice management system, ensuring all payments and denials are correctly posted
• Reconcile received checks with the practice management system, to ensure payment accuracy
• Separate the claims by primary, secondary and Worker’s Comp
• Communicate with team members and supervisors to resolve any discrepancies related to paper claims, correspondence and reconciliations
• Acts as backup to Cashier position, as needed
• Notify supervisor of consistent discrepancies
• Maintain compliance with all regulatory requirements for claim processing, correspondence handling, and appeals
• Prepare and maintain daily, weekly, and monthly reports on correspondence, claims processed, and reconciliations completed
• Work assigned work queus related to missing correspondence
• Convert virtual credit card payments into paper checks for accurate posting and reconciliation
• Maintain strict confidentiality of patient protected health information as mandated by STRG procedures and HIPAA Privacy, Security and HITECH regulation
• Perform other duties as required

Supervisory Responsibilities:

None

Experience / Skill Requirements:

Formal training which will probably be indicated by a high school diploma or equivalent; one year medical insurance experience; familiarity with CMS 1500 form.  Ability to operate a computer; operate standard office machines such as a copier and fax; 10 key by touch at a standard rate of 140 keystrokes per minute.

Education:

High School Diploma or GED

Attendance / Work Schedule:

Maintaining and satisfying minimum attendance requirements is an essential function of this position, including working all full-time regular hours as established for this position and scheduled or emergency overtime. Full-time regular hours are defined as Monday through Friday, with after-hours or weekends as required. All employees in this job classification are required to satisfy this requirement. This job classification does not include "light duty" work or allow unpredictable or unrestricted absences.