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Senior Medical Claims Clerk

3 months ago

Philadelphia, United States PATH People Acting To Help, Inc. Full time
Job DescriptionJob Description

ABOUT PATH INC.

PATH (People Acting to Help) Inc. is a comprehensive Community Behavioral Health and Intellectual Disability Center. We offer a wide of array of services and supports to meet the needs of our community in Northeast Philadelphia. PATH regularly achieves the highest levels of accreditation including a 5 Star Provider Rating by CBH, Philadelphia’s Managed Care Entity, and recognition and awards related to our high-quality, innovative programs and staff accomplishments and contributions.

Our Mission? To Help Individuals Achieve a More Independent and Fulfilling Life.


WHY WORK AT PATH?

A Career with Meaning

At PATH, our team members are at the heart of what we do, so we work hard to give them the best reasons to work here — and to stay here.

In addition to the satisfaction of making a real difference in people's lives, we offer:

• Competitive pay

• Annual increases

• Performance and longevity bonuses

• Comprehensive benefits package for staff and family

• Generous number of paid holidays, vacation, sick, and personal time

• No-cost pension plan

• Ongoing professional development opportunities, including licensure supervision

• Cutting-edge treatment facility, resources, and treatment modalities

• Opportunities for advancement and growth within the organization

• Eligible for the Federal Public Student Loan Forgiveness (PSLF) program

• Referral bonus for referring a friend who accepts employment

JOB SUMMARY:

To promote the mission of PATH to help individuals achieve a more independent and fulfilling life by being an effective team member. The Senior Medical Claims Clerk must be able to confirm and update client eligibility, prepare and submit 837P electronic billing files with consistency and accuracy for effective submission to our guarantors. The position must be able to download and review response files to the 837P electronic billing files, post electronic and manual payment files as received and perform all billing and cash posting tasks in a timely manner to maximize revenue and facilitate cash flow. Additionally, the position will work with various stakeholders to provide the necessary information to resolve all billing and funding discrepancies.

PHYSICAL DEMANDS:

Minimal in nature

QUALIFICATIONS:

High School Diploma. Two or more years’ experience in Medical Billing functions, preferably in a Behavioral Health non-profit environment. Must have data entry experience with Excel, Word, and experience using medical billing software. Ability to work with numbers and systems with minimal supervision. Experience and knowledge of Primary and Secondary insurance billing including the input of data, generation of electronic billing files and electronic and manual cash application of cash received from billings. Possess the skills needed to interact with outside parties to collect the necessary information for the successful submission of claims to various guarantors.

SPECIFIC DUTIES:

  1. Use various programs (Avatar/NX, AVA, Promise/EVS, Excel, etc.) to perform all billing functions.
  2. Download response files for Behavioral Health 837P billing including the TA1, 999 and/or 277 files within 2 business days of the submission of the 837P file.
  3. Transfer, rename and store all 837P billing files and related response files electronically in the appropriate assigned folders.
  4. Review the TA1 and 999 files to confirm the 837P files have been accepted for adjudication by the guarantor within one business day of the file downloads.
  5. Download all 277 files and use the EDI Power Reader to import/ export data into Excel so that the files are readable within one business day of the file downloads.
  6. Review the converted 277 files and work the claims on the file to resubmit claims within one week of conversion.
  7. Post Electronic Payment Files for all guarantors as assigned within one week of receipt and confirm posting with supervisor.
  8. Rebill services to Secondary Payers (CBH) as required within 1 week of the cash posting from the Primary Payer (Medicare).