Clerk, Billing

The Billing Clerk is a non-exempt position that reports to the Director of the Business Office. This role is responsible for managing the billing process, which includes preparing and transmitting accurate and complete bills to Medicare, Medicaid, and other third-party payers in a timely manner. The position requires critical thinking, decisive judgment, and the ability to work independently with minimal supervision. The Billing Clerk must be able to perform well in a stressful environment, take appropriate action, and adhere to established policies, procedures, objectives, safety standards, and confidentiality guidelines. Key responsibilities include processing 100% of accepted claims within one working day of receipt, editing claims to completion while utilizing all available resources to meet established guidelines, and entering documentation immediately upon receipt to maintain current and accurate account information. The Billing Clerk is also responsible for updating billing systems with demographic and/or insurance revisions within one working day of receipt, submitting claims that require additional information to the manager, and initiating follow-up with third-party payers no later than 15 days from the final bill. Additionally, the Billing Clerk must ensure that all accounts are worked to completion and adjudicated within 90 days of billing. The role involves actively following up on rejected and unpaid claims, obtaining and supplying payers with necessary documentation to expedite payment, and maintaining knowledge of relevant coding standards and payer guidelines for UB94 and HCFA 1500 claims. The Billing Clerk reviews accounts for accuracy, ensures correct patient balances and insurance portions are due, and guarantees that correct statements are mailed. The role also requires maintaining knowledge of payer contracts and reimbursement methodologies to ensure proper payment and correct patient portion due. Further responsibilities include reviewing and following up on charges credited or debited on patient accounts, monitoring denied, rejected, or pending claims via remittance advice, and ensuring reliable cash controls for timely and accurate cash applications to patient accounts. The Billing Clerk is also responsible for reconciling daily cash and adjustments postings, reviewing credit balances, and resolving issues within five working days. Additionally, they assist auditors, report any confidentiality breaches, and ensure that all correspondence and follow-up actions are completed in a timely manner. The Billing Clerk must demonstrate professional and courteous telephone etiquette, interact with the Patient Account Manager and Benefits Advisor as needed, and maintain accurate business office records. The position requires maintaining a clean claims submission rate of 80% or better and adhering to confidentiality standards in accordance with HIPAA regulations. Other duties may be assigned based on department needs, and the Billing Clerk must be prepared to assist in cross-training efforts and complete additional tasks as requested. To be successful in this role, the Billing Clerk must possess strong computer and keyboarding skills, the ability to work independently, and maintain a high level of professionalism in all interactions. The position requires flexibility and the ability to adapt to evolving department and hospital requirements.