Job Title: Billing Clerk I, II, III
Department: Patient Accounting
Reports To: Business Office Manager
FLSA Status: Non-Exempt
Wage Range that the Company Expects to Pay:
Under the direct supervision of the Business Officer Manager the Billing clerk is responsible for preparing and posting fee tickets for various sites and programs. Post and balance payments received. Handle all incoming billing calls. Work aging for various programs and payers. Send patient statements. Run month end reports. Submit third party claims electronically or manually. Ensure that all Providers/Facilities are paneled with the various insurances and state. programs. Maintain current knowledge of CPT, HCPC and ICD-9 coding practices. Also maintain knowledge of all programs and payer source requirements and guidelines.
It is the primary purpose of CHCCC to provide the highest quality of total care possible to the patient population it serves. Such a level of quality depends ultimately on the staff's desire and ability to work together, individually, and as a team. The employee is expected to be professional, punctual, maintain regular attendance, be cooperative, organized, and enthusiastic at all times.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Additional duties may be assigned with or without prior notice.
Clerk I:
Post daily fee tickets and/or incoming mail (charges, payments, adjustments) for various sites and programs electronically/manually. Review fee tickets for accuracy of diagnosis, CPT and HCPC coding. Check for covered services per payer source to avoid claim denials. Run daily posting and transaction reports to balance total charge, payments and adjustments. Check eligibility for third party insurances. Run missing fee ticket report to ensure that all fee tickets have been posted or voided. Assist patients/employees with billing/ insurance questions. Batch and balance third party RA's and distribute to billing clerks for correction when needed. Check CHDP claims for accuracy. Generate Re-bill and unbilled claims reports. Print and submit billing- claims to all third party insurances manually. Make necessary corrections to claims that have errors. Other duties may be assigned.
Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations.
Maintains and adheres to HIPAA, employee confidentiality, and privileged communications (patient, employee, and corporation).
Demonstrates cultural sensitivity and competence.
Clerk II:
Covers Billing Clerk I duties when on vacation or out sick.
Balance daily cash reconciliation sheet to ensure that all cash posted either by fee tickets, incoming mail or electronic cash receipts are balanced monthly. Prepare cash reconciliation excel spread sheet for finance monthly. Submit third party claims electronically and/or manually. Check claims error report and make necessary corrections for re- submissions. Train employees on various payers and programs. Work accounts receivable aging for third party Insurance, sliding fee and private pay. Also work denials from third party remittance advice/explanations of benefits. Run various month end reports to balance monthly billing activities.
Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations.
Maintains and adheres to HIPAA, employee confidentiality, and privileged communications (patient, employee, and corporation).
Demonstrates cultural sensitivity and competence.
Clerk III:
Has Billing Clerk I and II knowledge and covers when clerks are on vacation or out sick. Update and maintain Nextgen EPM file maintenance, BBP and libraries. Process EDI files for specialty services and work claims edits reports. Assist billing staff with coding, posting and Nextgen EPM questions. Update electronic billing format for Medi-cal/Medicare. Ensure that specialty services (inpatient and surgeries) and modifiers are coded correctly to receive allowed reimbursement with no reductions.
Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations.
Maintains and adheres to HIPAA, employee confidentiality, and privileged communications (patient, employee, and corporation).
Demonstrates cultural sensitivity and competence.
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
Clerk I:
High school diploma or equivalent required. Two years of experience in medical billing and collections. Must be able to establish and maintain effective working relationship with internal and external customers. Must be organized. Computer literacy required.
Clerk II:
Same as Billing Clerk I, plus experience with billing of inpatient services, procedures and surgeries. Knowledge of all billing modifiers and CPT, ICD9 and HCPC specialty coding.
Clerk III:
Same as Billing Clerk II, plus experience with report generation. Work all payer source aging reports. Help with new staff training. Set up/update Nextgen practice management system with new providers, insurance information and system master files. Panel all providers with the various Insurance companies. Transmit claims electronically to various payers.
LANGUAGE SKILLS
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of an organization. Bilingual in English and another language is preferred, but not required.
MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
REASONING ABILITY
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
COMPUTER SKILLS
Experience with word processing, spreadsheets, email, and keyboarding is required. Microsoft Office and Google Suite skills are required.
CERTIFICATES, LICENSES, REGISTRATIONS
Possession of current, valid, unrestricted California Driver's License (Class C) required.
OTHER REQUIREMENTS
Required to pass a criminal history background check and drug screen upon hire. Annual health examination; annual Tuberculosis skin test clearance or chest x-ray; proof of immunity to MMR, Varicella, and Hepatitis B; proof of Tdap vaccine; during current flu season, must provide proof of influenza vaccine or a signed declination form. If declined, a flu mask is mandatory during flu season. Health screening requirements are subject to change based on CDC recommendations and federal, state, and/or local public health ordinances.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to sit. The employee is occasionally required to stand and walk. The employee must regularly lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently exposed to moving mechanical parts. The employee is occasionally exposed to the risk of electrical shock. The noise level in the work environment is usually moderate. Must be able to work in a fast-paced environment.
Must be willing to have a flexible work schedule that may include evenings/weekends, and travel as needed.
Community Health Centers of the Central Coast, Inc. (CHC) is a 501(c)3 non-profit network of Federally Qualified Health Centers (FQHC’s) in San Luis Obispo and northern Santa Barbara counties. CHC provides comprehensive and affordable healthcare, including Primary Medical Care, Family Dentistry, Chiropractic, Pediatrics, Women’s Health, Optometry and Behavioral Health services.
