Billing Clerk I

Delaware Valley Community Health•Norristown, PA

8d•Onsite

About The Position

This position is responsible for the submission and resubmission of claims and payment postings. Evaluates, updates, and verifies patients’ insurances including commercial. Determines sliding fee scale for all new and established under-insured and uninsured patients. Collects daily monies paid by patients, issues receipts, reconciles receipts, and delivers daily summary worksheet to the accounting department. Aids patients in contacting their HMO if patient is assigned to another provider and wishes to become capitated to DVCH. Refers possible candidates to the Billing Clerk IV or the Social Worker via in-house referral form. Verifies accuracy and completeness of encounter forms prior to data entry. Verifies accuracy of data entered (i.e., facility, provider, date of service, payor code, diagnosis, and procedure). Completes data entry from encounter forms on daily basis. Obtains authorization for OB patients, when required. Faxes and mails all OB data forms, such as Baby Blueprints and KMHP forms. Stamps all authorized prescriptions presented by patients after seeing their provider. Completes data entry and reviews day sheets and charge entry user audits for accuracy and completion. Answers questions from patients and staff regarding billing and forwards calls to the Billing management as appropriate. Contacts practice management system for resolution of software issues, when necessary. Contacts insurance carriers to resolve questions/issues, when necessary. Explains the benefits and eligibility standards for the different insurance programs to DVCH patients. Determines the appropriate insurance program for the patient. Assists patients who are denied benefits with the appeal process, if warranted.

Requirements

A high school diploma or equivalent is required.
Excellent interpersonal and oral and written communications skills are required.
Excellent analytical skills are required.

Nice To Haves

Previous billing experience in a health care setting is highly preferred.
Prior knowledge of the various insurance plans in which the organization participates is preferred.

Responsibilities

Submission and resubmission of claims and payment postings.
Evaluate, update, and verify patients’ insurances including commercial.
Determine sliding fee scale for all new and established under-insured and uninsured patients.
Collect daily monies paid by patients, issue receipts, reconcile receipts, and deliver daily summary worksheet to the accounting department.
Aid patients in contacting their HMO if patient is assigned to another provider and wishes to become capitated to DVCH.
Refer possible candidates to the Billing Clerk IV or the Social Worker via in-house referral form.
Verify accuracy and completeness of encounter forms prior to data entry.
Verify accuracy of data entered (i.e., facility, provider, date of service, payor code, diagnosis, and procedure).
Complete data entry from encounter forms on daily basis.
Obtain authorization for OB patients, when required.
Fax and mail all OB data forms, such as Baby Blueprints and KMHP forms.
Stamp all authorized prescriptions presented by patients after seeing their provider.
Complete data entry and review day sheets and charge entry user audits for accuracy and completion.
Answer questions from patients and staff regarding billing and forward calls to the Billing management as appropriate.
Contact practice management system for resolution of software issues, when necessary.
Contact insurance carriers to resolve questions/issues, when necessary.
Explain the benefits and eligibility standards for the different insurance programs to DVCH patients.
Determine the appropriate insurance program for the patient.
Assist patients who are denied benefits with the appeal process, if warranted.