Job Description
Position Title: Insurance Clerk
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Primary Purpose Of The Position:
Responsible for coding and entering charges for CHC physician practices and those physicians under a billing agreement. Responsible for making office and business office deposits. Posting payments to the correct physician system. Balancing day sheets/computer reports with data entered into the computer system. Generate accurate reports that correspond with data entered for the day. Work hand and hand with the physician offices to get complete information required to bill correctly. Process insurance claim forms and patient statements weekly/monthly. Work aged accounts. Rebill insurance companies/patients for balances due. Keep current with billing guidelines and third party requirements. Keep current with ICD-10-CM and CPT-4 coding guidelines. Review aged trial balances and work on a regular basis. (At least once a quarter if not more frequent) Assist patients and insurance companies with any correspondence/questions/complaints regarding their bill. File insurance explanation of benefits in proper filing order. Keep daily transactions in order. Keep daily-generated reports in order.
Responsibilities * Indicates Primary Duties/Responsibilities
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and are critical or fundamental to the performance of the job. Following are essential functions/standards of the job, evaluate how the employee performed relative to these standards by checking the appropriate box.
*Accurately and legibly codes super bills with ICD-10-CM and CPT-4 codes.
*Enters proper information from superbills into the computer system.
*Follows up with the physician office for information needed to complete data entry of bills. Reports ongoing issues with physician offices to coordinator.
*Reconciliation of super bills, day sheets, computer reports and bank deposits.
*Post payments, adjustments-recording information from explanation of benefits.
Payments/adjustments must be posted in a timely manner
All adjustments must be reviewed for appropriateness prior to posting.
Only adjustments on an explanation of benefit and within contract guidelines are to be posted without the coordinator's review.
Reconciliation of posting via computer and bank deposits
Timely filing of all secondary claims
*Month-end process: All charges, payments and adjustments need to be entered by the second work day of the new month.
*Follows up with insurance companies who request information or call regarding patient accounts or accounts greater than 60 days old.
*Follows up with patient calls with a response to the patient within one working day.
*Quarterly reviews of aged trial balance. Rebilling insurance/patient. Getting accounts ready for collections if needed.
*Keeps abreast of new coding and insurance regulations and guidelines through seminars, newsletters, journals, internet.
*Reviews billing guidelines to make sure data entry/insurance forms are correct.
*Continuous daily operations of CHC.
Daily filing of CHC explanation of benefits.
Daily organization of incoming and outgoing mails.
Organization of 1500/319 forms, superbills, day sheets.
Performs other duties as assigned to support the efficient operation of the department.
Additional Duties/Comments:
Additional Responsibilities
I. Organizational Responsibilities
Promotes in a positive manner, WMCHC's Mission, and Core Values.
Displays identification badge in proper manner while on duty.
Adheres to organization/departmental policy on conduct and appearance.
Demonstrates dependability, arrives at work on time, reports on scheduled days, adheres to break and meal schedules.
Maintains and fosters a culture in accordance with the Corporate Compliance program.
Adheres to all organizational policies and procedures as set forth in the Centers Policy and Procedure Manual, Human Resources Policy and Procedure Manual and Departmental Policy & Procedure Manuals.
Additional Duties/Comments:
II. Confidentiality
HIPAA compliance - complies with all of the privacy & confidentiality policy & procedures outlined in the HIPAA Program of Wayne Memorial Community Health Centers. All information encountered during course of employment is treated as confidential and privileged information. Complies with all policy and procedure pertaining to computer passwords, downloading information, transmission of information, etc.
Additional Duties/Comments:
III. Customer Service
Anticipates and exhibits a dedication to meeting the expectations of internal/external customer needs in a timely manner.
Ensures customer satisfaction through process of monitoring, developing, improving, and delivering excellence in products and services.
Respects the diversity of cultural/religious beliefs of the community served.
Ensures timely resolution of problems, concerns and complaints of all customers served.
Additional Duties/Comments:
IV. Communication
Demonstrates the ability to interact in a clear and logical manner while maintaining a positive and professional communication pattern, verbally and in writing, with peers, management and associates within the department/organization.
Identifies self and clarifies role to patient, family, staff, healthcare providers, students and other associates within department and organization.
Additional Duties/Comments:
V. Teamwork
Establishes constructive relationships with team members by demonstrating a willingness to work with and assist all members of the healthcare team to ensure customer satisfaction.
Addresses concerns or conflicts with members of the work team in a mature and professional manner.
Additional Duties/Comments:
VI. Safety
Demonstrates and maintains approved infection control policies and standards.
Maintains familiarity with Emergency Response procedures and responds appropriately to all emergency codes.
Appropriately reports all accidents and dangerous situations by notifying necessary persons and completing required reports.
Demonstrates awareness of and performs in accordance with the Patient Safety Improvement and Management Plan
Demonstrates proper and safe body mechanics as taught in Back Safety program.
Maintains familiarity with Material Safety Data Sheets (MSDS).
Additional Duties/Comments:
VII. Continuing Education
Possesses and maintains cognitive and technical knowledge and the ability to progressively manage care delivery across the continuum of care.
Demonstrates commitment to ongoing professional growth.
Actively contributes to performance improvement initiatives.
Complies with mandatory organizational continuing education policy.
Maintains organizational and departmental job specific competencies.
Additional Duties/Comments:
Competency Assessment
The process of ensuring that each employee demonstrates continued ability to perform the tasks, duties, and responsibilities of his/her position in a competent fashion. Following are the competency standards for the position. Indicate how the employee demonstrates competency relative to the standard listed by checking the appropriate boxes.
Departmental Competency:
Demonstrates and facilitates accuracy with details and strong organizational skills.
Demonstrates and facilitates appropriate knowledge of Patient Accounting Computer Software application, spreadsheet software application, email, and word processing.
Demonstrates and facilitates appropriate knowledge of filing system.
Demonstrates and facilitates appropriate knowledge for use of copier/printer, adding machine, fax machine, and time clock.
Additional Duties/Comments:
Minimum Qualifications:
Requires the ability to communicate effectively, good organization skills, and detail oriented;
Legible handwriting; personable phone skills; and computer experience preferred;
Responsible party needs to be self-motivated; good at managing time effectively; able to work well with others and independently, adapt to any challenges that may put forth to him/her;
Must be willing to learn and keep abreast on all billing guidelines and third party requirements;
Experience with medical terminology, ICD-10-CM and CPT-4 coding and medical billing preferred.
Job Tags
Contract work, Part time,