Billing Clerk at RAWLINS COUNTY HEALTH CENTER – Atwood, Kansas

Summary:

Works cooperatively with all hospital departments, medical staff, patients, and visitors. Handles all aspects of the billing process in Hospital and Clinic claims and assists with other Business Office functions as assigned.

Essential Functions:

1. Edits all insurance claims (primary and/or secondary dependent on current outsourced contract in place) (clinic/professional and institutional claims) and submits them to the proper insurance for reimbursement.
2. Submits adjustments to insurance companies for reimbursement of late charges and/or corrections of clinic/professional and institutional charges.
3. Assists to resolve issues on insurance claims.
4. Follows up on denials and write-offs to see if appeal needs to be made, work with other departments involved to get needed information.
5. Ensures that research is completed on all denials before requesting write-offs to accounts.
6. Communicates with the Revenue Cycle Manager and Chief Financial Officer for approvals prior to any write-offs being completed.
7. Explains financial requirements to the patient or responsible party according to patients’ individual insurance policy benefit.
8. Explains Good Faith Estimate to patients that are self-pay or underinsured.
9. Reviews clinic and hospital admissions to ensure accurate financial and biographical data and documentation have been obtained and properly entered into the records.
10. Coordinates with clinic and hospital staff and other resources to ensure appropriate placement of patients.
11. Complies with third party payers and other regulations.
12. Compiles and distributes information regarding patients' personal, insurance, and financial status as needed.
13. Assists in exceeding standard billing goals that are reported monthly on the Administrative Report.
14. Downloads and balances applicable insurance remittance advices
15. Reviews remittance advices to ensure proper payment is being received.
16. Verifies and investigates discrepancies in the dates of admission and discharge in cooperation with other departments.
17. Verifies and investigates discrepancies in patient charges according to chart documentation.
18. Assists with phone calls as necessary.
19. Responds to emergency calls following established protocols.
20. Assists callers by paging overhead as necessary.
21. Research all information to complete the billing process.
22. Processes and distributes copies of billings as required.
23. Makes written and/or verbal inquiries to third party payers to reconcile patient accounts.
24. Answers inquiries regarding patient accounts or directs questions to Financial Services Representative.
25. Assists with updating the Chargemaster fees on an as needed basis and setting up new charges as needed.
26. Submits new charges and any changes to current charges to be corrected.
27. Maintains provider billing numbers and facility enrollment in accordance with insurance regulations
28. Applies for provider billing privileges for all lines of insurance for new providers.
29. Provides coverage at hospital and clinic registration desk when needed.
30. Completes Medicare bad debt logs for year-end cost report.
31. Completes other duties as requested.

Competencies:

1. Able to work independently and focus on the task at hand in a busy environment.
2. A positive attitude and people skills are a necessity.
3. Must be detail oriented and perform a thorough job in all responsibilities.
4. Must have excellent telephone etiquette.
5. Proficient with filing and maintaining patient charts.
6. Strong Word and Excel spreadsheet skills.
7. Able to operate photocopier and fax machine.
8. Strong customer service skills.

Position Qualifications:

Minimum Education:

Minimum of a high school education or GED. Some college is preferred.

Minimum Experience:

One plus years of basic office experience is preferred. Basic computer knowledge is required.

Working Environment: In-door, climate-controlled office setting that is occasionally very busy. This position includes potential hazards/risks related to ergonomics/body mechanics, infectious agents, hazardous substances, and mechanical/electrical equipment.

Professional Requirements: Adheres to policies and procedures and always maintains confidentiality. Attending annual in-services completes annual education promptly. Represents RCHC positively and professionally on the job, electronically, and in the community. Complies with all hospital policies regarding ethical business practices; communicates the mission statement & core values of RCHC both on and off the job.