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Business Office Clerk
2 months ago
DESCRIPTION: Duties include submitting third party claims to proper agency, posting payments, and following up on AR. Performs complex clerical work and light bookkeeping and accounting work. Uses adding machine and deals with automated patient data base and related systems.
SUPERVISION: Directly supervised by the Business Office Manager.
TYPICAL PHYSICAL DEMANDS: Requires prolonged sitting. May require moving up to 25 pounds. Requires the use of office equipment, such as computer terminals, telephone and copiers.
FUNCTIONS AND RESPONSIBILITIES:
- Uploads charges and receipts, closes the day, compiles and prints daily reports.
- Reviews and electronically transmits third party claims, including billing for Medicare crossovers.
- Maintains a log of all electronically and hardcopy (paper) filed claims.
- Generates and prepares statements to be mailed to all proper contracted agencies, when applicable.
- Prints accounts receivable report and works the outstanding balances.
- Responsible for downloading and printing Medicare, Medicaid, and third party Remittance and Status Reports or EOBs.
- Posts payments for all third party claims to patient's account as per R&S or EOB.
- Runs receipts report to verify that all payments are posted by site and that the check amount reconciles with the computer total.
- Reviews, corrects and appeals rejected claims and answers any associated correspondence from the claim processing.
- Researches and resolves outstanding claims and payment issues for all third-party billing and resubmits claims accordingly or initiating the appeal process if needed.
- Investigates all denied third party claims by rejection code and acts accordingly in coordination with the related provider, if applicable, to file appeals on rejected claims.
- Ability to view clinical data to fulfill responsibilities.
- Responsible to generate monthly reports for all payments received from hospital services rendered by Center providers and works with HR to ensure the provider receive inpatient reimbursements as per individual contracts, if necessary.
- Creates charges in Practice Management System for all Home Health patients.
- Attends to patient complaints regarding services provided by business office, including account balance and statement inquiries.
- Follow-up on self-pay patient AR.
- Establish payment plans and follow-up.
- Completes write-off report provided by supervisor.
- Follow-up on returned mail.
- Assists in the completion of appropriate, accurate and timely Center and provider enrollment and credentialing with Medicare, Medicaid, and all third-party payers contracted with the Center.
- Covers the "window" and bills patients in the absence of the billing clerk.
- Performs other duties as assigned.
MINIMUM QUALIFICATIONS:
- Graduate from an accredited high school or GED graduate.
- Two years in an accredited technical/vocational school with one-year experience or four years' experience in this field.
- Knowledge of medical terminology is preferred.
- Bilingual in English and Spanish is preferred.
SKILLS AND ABILITIES:
- Must be able to carry out verbal and written instructions.
- Must be computer literate.
- Ability to interpret, understand and carry out instructions and orders.
- Ability to maintain patient confidentiality.
- Ability to effectively communicate verbally and in writing.
- Ability to work flexible hours.
- Knowledge of clinical and operational functions performed in a primary care setting.
- Knowledge of individual as well as group dynamics and community organizations.
