Billing Clerk 3

Department: Billing

Position:  Billing Clerk III

Employee Category:  Non-Exempt

Reporting Relationship: Manager of Revenue Cycle Management

Character First Qualities:

• Decisiveness- The ability to recognize key factors and finalize difficult decisions.
• Dependability- Fulfilling what I consented to do, even if it means unexpected sacrifice.
• Flexibility- Willingness to change plans or ideas without getting upset.
• Patience- Accepting a difficult situation without giving a deadline to remove it.
• Tolerance- Accepting others at different levels of maturity.

Summary of Duties and Responsibilities:

The Billing Clerk III is responsible for reviewing and scrubbing claims, filing third-party claims, self -pay patient billing and answering billing questions from patients and staff. They are also responsible for the administration of special programs as assigned.

Primary Duties and Responsibilities: 

1. Reviews assigned claims daily to ensure accuracy prior to claim submission.
2. Reviews work of other Billing staff and answer questions when needed.
3. Assists with training of new and existing staff.
4. Reviews documentation on self-pay claims to ensure that the appropriate discount is applied.
5. Makes billing corrections and adjustments to claims as appropriate to ensure prompt payment and accuracy of balance.
6. Validates the correct payer for claim as well as verify patient eligibility when in question.
7. Contacts patients for missing information or clarification of documentation.
8. Requests documentation and/or information required to process claims. Scans and uploads documentation and information to patient accounts as applicable.
9. Submits claims to clearinghouse daily.
10. Processes secondary and tertiary claims accurately and timely to ensure payment.
11. Coordinates with the Claims Resolution Specialists to assist in investigating denied claims and credit balances and coding corrections.
12. Completes rejection and rebill requests.
13. Follows up on pending claims and work to resolution.
14. Assists with patient phone calls regarding balances and benefits; advises patients of deductibles and co-payment status.
15. Assists patients with payment arrangements by coordinating with a Collection Specialist. Issues individual statements when necessary on patient accounts.
16. Assists the front staff with billing and eligibility related questions.
17. Keeps abreast of the variety of programs offered at each site and applies benefits correctly to patient charges.
18. Maintains billing for special programs as assigned.
19. Produces itemized billing requested by law firms or other agencies.
20. Processes DLO invoices monthly and sends all requested information from accounts.
21. Creates daily deposit slips on self-pay and private pay accounts.
22. Collect credit card payments from patients and post to respective accounts.
23. Keeps current with dental, behavior health, and vision claims and processes.
24. Reports trends to Manager of Revenue Cycle Management for review and action.
25. Meets established daily, weekly, monthly, and annual deadlines.
26. Upholds Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information.
27. Follows written and verbal instructions from the Manager of Revenue Cycle Management.
28. Exhibits professionalism in communication with patients, clients, insurance companies and co-workers.
29. Participates in special projects as assigned.
30. Supports Variety Care’s accreditation as a Patient Centered Medical Home and our commitment to provide care to all Variety patients that is Safe, Effective, Patient Centered, Timely, Efficient, and Equitable. Provides leadership and work with all staff to achieve the goals of the “Triple Aim” of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs.
31. Embodies the strength of personal character. Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment.  Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable.
32. Performs other duties as assigned.

Requirements, Special Skills or Knowledge: 

1. High school diploma or GED.
2. Five years of experience in third party billing in a Family Practice setting.
3. Experience filing third party claims and reports in a timely manner.
4. Experience interacting and communicating effectively with individuals at various levels both inside and outside the organization, often in sensitive situations.
5. Bilingual (English/Spanish).
6. Basic knowledge of CPT codes. Experience monitoring coding changes to ensure that the most current information is available.
7. Basic knowledge of medical terminology and protocols.
8. Basic knowledge of coding and anatomy.
9. Mastery of critical thinking, analytics, problem-solving and sound decision-making skills.
10. Proficiency with Microsoft Office and practice management software systems.
11. Experience assisting and supporting others in a professional and respectful manner.

ADA Requirements:

1. Must be able to lift 25 pounds.
2. Must be able to sit for extended periods of time.
3. Must have excellent concentration ability.