Billing clerk

Bills all insurance companies, other than Medicare, for all hospital bills. Pursues collection of all claims until payment is made by insurance companies.

Performs other work associated with the billing process, including compiling information for other outside sources, such as attorneys.

Essential Duties and Responsibilities :

• Prepares and submits hospital claims to third party insurance carriers either electronically or by hard copy billing.
• Secures needed medical documentation required or requested by third party insurances.
• Follows-up with third party insurance carriers on unpaid claims until claims are paid or only self pay balance remains.
• Processes rejections by either making accounts private or generating a letter of rejection to patient, or corrects any billing error and resubmits claims to third party insurance carriers.
• Works with physician or medical record staff to ensure that correct diagnosis / procedures are reported to third party insurance carriers.
• Makes accounts private and notifies patients when claims have not been paid, after time frames established for accounts receivable policy.
• Keeps updated on all billing and benefit changes for third party insurance carriers.
• Monitors claims for missing information, authorization / control numbers. Sends appeals and adjustments on claims for issues such as no precertification, late charges, and incorrect charging.
• Compile itemized bills for patients at the request of attorney(s).
• Maintains strict confidentiality of all information.
• Completes work within authorized time to assure compliance with departmental standards.
• Keeps updated on all third party billing requirements and changes for insurance types within their area of responsibility, such as Medicaid and Blue Cross / Blue Shield.
• Demonstrates knowledge of, and supports, hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
• Works with Physical Therapy department on pre-certifications and authorizations through Worker’s Compensation, Auto Insurance and other third party payers.
• Other duties as may be assigned.

Job Requirements

Education : High School diploma or GED required; Associates preferred. Or, specialized training in Insurance billing and data entry.

Experience : At least one year prior experience in billing of third party insurances for professional services, required.

Ability to file insurance claims by hard copy and electronically. Must show maturity in dealing with co-workers. Good verbal and written communication skills are essential.

Ability to effectively communicate and interact with colleagues, hospital staff, patients, public, physicians and their staff and third party insurance personnel.

Ability to work under stress, with interruptions and deadlines.

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Last updated : 2024-11-02