Billing Clerk

Billing Clerk

Position Summary: This position is responsible for the revenue billing for the Senior Care Options (SCO) and One Care Insurance plans and acts as a liaison between the SCO and Finance Departments. The Billing Clerk will be responsible for the billing life cycle which includes processing claims, resolving exceptions, late billing, monitoring & rebilling claims, and ensuring compliance with company policies and industry standards.

Principle Accountabilities:

• Claims Processing : Create, send, and track invoices for services rendered, using billing software. Download POS billing claims from state database & upload claims into claims management software.
• Invoicing : Submits required documentation to the health plans for reimbursement with case management, CDC, and training invoicing.
• Payments : Provide finance with expected payments.
• Acknowledgements : All uploads, 277, 999 and 835s received for submitted claims to Wellsky and documentation saved in appropriate directory.
• Exceptions : Reviews, adjusts, and reprocesses claims which are plan exceptions caused by manual error. Resolve discrepancies, monitor issues related to claims and rebilling in a timely manner.
• Compliance : Maintain accuracy & compliance with HIPAA guidelines.
• Reporting : Prepare reports on required billing formats. Reports on billing activity, delinquency payments, and duplicate entries.
• Coordination : Collaborate with SCO team to ensure accurate billing, rosters, and timely collections.
• Accounts Receivable Oversight : Monitor unpaid or denied claims for outstanding or overdue payments to ensure billing is accurate.
• Procedures : Maintain up to date procedures.
• Online Training : To remain current with billing processes and procedures.
• Vendor and Client Billing : Cross-train and assist with accurate, timely vendor billing, and late billing.
• Special Projects, Assignments, and Tasks : As assigned.

Qualifications:

Education : High School diploma or equivalent.

Experience : One to two years of billing experience and/or use of MassHealth 277, 837, 835 claims files preferred.

Special Skills/Knowledge : Experience with claims management system software preferred, intermediate computer skills, proficient in Microsoft Office Suite (Word, Excel, Outlook, & Teams), attention to detail, accuracy, ability to work independently and as part of a team, and to prioritize, ability to multi-task and work in a fast-paced, high-volume environment, proven organizational and time management skills, good oral communication skills. Driver's license and reliable transportation are required.

This job description is intended to be general, will evolve over time, and is subject to periodic updating. This job description does not constitute a written or implied contract of employment.

EOE M/F/D/V