Billing Clerk

Lifepoint Health • Ishpeming, MI

2d • Onsite

About The Position

UP Health System- Bell, part of Lifepoint Health, is seeking a Billing Clerk to join their team. This role involves following established policies and procedures, processing claims efficiently, editing claims to completion, and maintaining accurate account information. The Billing Clerk will be responsible for updating the billing system, submitting claims requiring additional information, and initiating follow-up with third-party payers. The position requires active follow-up on rejected and unpaid claims, obtaining necessary documentation to expedite payment, and maintaining current knowledge of coding and payer guidelines. Responsibilities also include reviewing accounts for accuracy, maintaining knowledge of payer contracts, processing adjustments, reconciling cash, resolving credit balances and correspondence, and operating the electronic remittance system. The role involves making referrals to appropriate departments, informing management of issues, guarding patient confidentiality, assisting auditors, and notifying management of absences. Specific duties may vary daily and will be assigned by the manager to ensure cross-training. The Billing Clerk will also interact with the Patient Account Manager and/or Benefits Advisor regarding patient coverage and follow up with patients regarding insurance problems, demonstrating professional telephone etiquette and maintaining business office records. The goal is to maintain clean claims submission to 80% or better and adhere to HIPAA regulations.

Requirements

• High School diploma or equivalent.
• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.
• Previous insurance billing experience or analytical experience determining priorities, where options are limited.

Nice To Haves

• Two years of college coursework completed or equivalent work experience.

Responsibilities

• Follows established policies and procedures, objectives, safety standards, and sensitivity to confidential information.
• Process 100% of accepted claims within one working day of receipt.
• Edit claims to completion, exhausting all resources to meet established guidelines.
• Enter 100% documentation immediately upon receipt, keeping account information current and accurate.
• Update billing system with demographic and/or insurance revisions within one working day of receipt.
• Submit daily to manager those claims requiring additional information from Admitting/Registration staff.
• Initiate follow up to third party payers no later than 15 days from final bill.
• Work accounts to completion to ensure adjudication within 90 days from bill.
• Actively follow up on all rejected and unpaid claims.
• Obtain and/or supply payers with necessary information and/or documentation to expedite payment in accordance with payer guidelines.
• Maintain current knowledge of CPT-HCPCS and ICD- 10 coding in accordance with third party payer guidelines for UB94 and HCFA 1500 claims.
• Review accounts for accuracy of patient balances and insurance portions due, to ensure correct statements are mailed.
• Maintain knowledge of payer contracts and reimbursement methodologist to insure correct payment and patient portion due.
• Review and follow up on any charges credited or debited on patient accounts in accordance with established guidelines.
• Follow up on denied, rejected and/or pending claims via remittance advice, Medicare FSS and other electronic systems within two working days or receipt.
• Maintain reliable comprehensive cash controls to ensure timely and accurate cash applications to patient accounts.
• Apply payments, calculate, process and generate adjustments not completed by the electronic remittance process within one working day or receipt.
• Prepare daily reconciliation of cash and adjustment posting and forward a copy to the accounting department.
• Review and research credit balances and resolve within five (5) working days.
• Resolve all incoming no payment correspondence within five (5) working days.
• Remain knowledgeable in the operation of the electronic remittance system to facilitate use when needed.
• Make referrals of accounts to appropriate department, with a high level of accuracy, for payment offsets and appeals.
• Keep manager appropriately informed of problems/issues or needs of the department.
• Guard the confidentiality of patient record and report any breach of confidentiality to the manager.
• Assist auditors with requested information for review of accounts and process corrected claims as necessary.
• Notify department manager of absence or tardy, giving sufficient notice to provide coverage for the work area.
• Specific duties (may vary daily) to be performed will be assigned by the manager depending upon the needs and requirements of the department and hospital to ensure all individuals are crossed trained in each area of responsibility.
• Interacts with Patient Account Manager and/or Benefits Advisor related to patients with limited or no insurance coverage, personal portion payment and deductibles owed; and follows up with patient regarding insurance problems via phone or mail.
• Demonstrates professional, courteous, caring telephone etiquette.
• Retains business office records in readily retrievable fashion.
• Maintains clean claims submission to 80% or better.
• Maintains confidentiality in accordance with HIPAA regulations.

Benefits

• Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Ongoing learning and career advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED