Patient Business Services Clerk

Description

Under supervision, to maintain complex and varied acute care and outpatient medical accounts primarily through either (1) a billing and accounts adjusting role, or (2) a collecting and problem accounts researching role.

Typical Tasks

• Reviews, checks, researches, and completes pre-billing information in order to prepare billing statements for patients and other payors;
  
• Compares summary claims against detailed itemization of charges;
  
• Combines inpatient and outpatient accounts of individual patients;
  
• Initiates various adjustments and transfers within patient accounts receivable;
  
• After payment by a primary payor, calculates leftover charges and bills secondary payor;
  
• Adjusts accounts, justifies, and totals designated uncollectible charges or bills;
  
• Breaks down charges as billable or not according to various insurance coverage;
  
• Reviews prepared bills for errors;
  
• Researches and reopens closed accounts in order to apply further payments received;
  
• Researches individual accounts to determine whether over-payments can be applied to another account, or to another agency, or should be refunded;
  
• Researches accounts subject to bankruptcy proceedings and determines whether to adjust account balances or assign for collection externally;
  
• Reviews insurance covered accounts to ensure that claims were valid, compliant with regulatory requirements, properly submitted, correctly paid and that remaining liabilities are appropriately assigned;
  
• Researches a variety of billing, accounts, and remittance records in order to track and explain account problems and discrepancies in response to inquiries and complaints;
  
• Notifies patients of their liability when uninsured or when insurance does not cover entire charges, and prepares reimbursement plans;
  
• Determines whether to refer a delinquent account to collection agency or to recycle it for review in the next period;
  
• Assists in orienting new employees to procedures and assignments in the unit;
  
• May prepare spread sheets on more complicated accounts;
  
• May interview patients to determine ability to pay and to establish a payment plan or assist in completing forms and paperwork;
  
• Performs other related duties as required.

Employment Standards

Demonstrated education, training, or clerical work experience which has provided an opportunity to acquire the following knowledge and abilities:

Experience Note: Normally a candidate would acquire the qualifications listed below through six months of clerical billing, collection or accounting work within the department, or one year of similar experience in a medical setting outside of the County's medical services.

Knowledge of:

• Medical terminology and insurance claim procedures common to medical billing and accounts receivable operations;
  
• Billing and account records maintenance procedures;
  
• Modern office administrative practices and procedures including computer skills;
  
• Purpose and use of International Classification of Disease Standards;
  
• Purpose and use of the Concurrent Procedure Terminology;
  
• Principles and practices of customer service and telephone courtesy;
  
• Legal requirements of State, Federal and SCVH&HS Policies and Procedures related to billing and collection activity and the release of confidential patient information;

• Operate a ten key adding machine;
  
• Make arithmetical computations of moderate difficulty;
  
• Understand and apply moderately complex medical services, insurance, and billing or accounts maintenance relationships, rules and procedures;
  
• Type simple forms and schedules;
  
• Establish and maintain effective working relationships with all levels of medical, professional, administrative and support personnel contacted in the course of work;
  
• In some assignments research, explicate, and prepare spread sheets on complex billing, accounts receivable, and insurance coverage records;
  
• In some assignments, interview in order to gather specific information regarding problem accounts and explain the accounts clearly;
  
• In some assignments, evaluate ability to pay and prepare routine payment plans.