BILLING CLERK

Billing Clerk

Under the supervision of the Billing and Supervising Coder, the Billing Clerk will provide assistance with billing and clerical support services, as well as receptionist functions to the Billing department.

Specific duties and responsibilities include:

• Charge batches verification and pre-coding via PM/EHR.
• Ensuring all expected charges are received from providers.
• Verifying eligibility and authorization is obtained and correct insurance is present in PM.
• Verifying documentation has been received for all new patients and specialty programs (Grants, PRC, Direct) including demographics, insurance and claim information.
• Verifying appropriate use of CPT codes, ICD-10 codes and modifiers for all billable encounters.
• Daily processing of claims and claim edits.
• Correcting claim rejections through the clearinghouse.
• Collection of outstanding balances from insurances and patients.
• Creating EFT/Fiscal batches and posting corresponding insurance and patient payments.
• Creating, reviewing and mailing patient statements weekly.
• Establishing and maintaining patient payment plans.
• Checking status of unpaid claims.
• Providing additional documentation to get timely reimbursement.
• Managing and preparing documents for accurate claims follow-up.
• Reviewing remit codes from EOB and ERA to identify denials and non-payments.
• Following up with payer on the routing of claims.
• Communicating with the Billing and Coding Supervisor on all payer issues, problems and trends in a timely manner to guarantee resolution and reimbursement.
• Documenting all follow up pertaining to the resolution of patient accounts.
• Ability to work a flexible schedule may be required based on need.
• Other duties as assigned.

Qualifications:

Education/Experience: Certificate from a medical institute or an Associate of Arts or Science Degree and at least two (2) years of experience in Medical/Dental/Pharmacy/Behavioral Health field preferred. Prior billing and collection experience preferred. Knowledge of medical terminology, anatomy and physiology, CPT, HCPCS, and ICD-10 coding experience required.

Previous IHS/FQHC experience preferred. NextGen Healthcare EHR/EMR experience preferred.

Licenses/Certifications: A valid California driver's license required with application submission and must be maintained throughout employment. Applicant must be insurable under SIHC vehicle insurance policy at the time of hire and throughout employment.

Certifications and/or licenses appropriate to the positions required education and profession must also be valid and maintained.

Character: Applicants must have a reputation for honesty and trustworthiness. Must be responsible and able to exercise good judgment, accept feedback and constructive criticism from supervisor, pay attention to detail, follow instructions, including the ability to interact effectively and communicate with patients and coworkers in a professional and courteous manner. Must be highly confidential and work as a team with other staff. Applicant should be sensitive to the needs of patients.

Skills: Strong customer service, team building, interpersonal, and organizational skills. Ability to establish and maintain effective peer relationships with coworkers within the department, interdepartmentally, and the public. Must be able to express ideas clearly, concisely, address audiences effectively, and exercise balanced judgment in evaluating situations and making decisions. Willing to be part of a team and cooperate in accomplishing department goals and objectives. Ability to prioritize, meet deadlines, take initiative, be proactive, resourceful, and function in a rapidly changing environment. Ability to work with people of all social and ethnic backgrounds and to resolve conflicts, negotiate situations and facilitate consensus.

Physical and Personal Requirements: Normal clinic/office environment. Sit or stand for long periods of time. Reach, bend, climb, stoop, lift up to 25 lbs. repetitive hand movement; use and view PC. Reliable transportation and car insurance as required by the state. Travel as needed.

Compliance: Each employee plays a key role in creating a compliance culture at SIHC. Employees are expected to learn and comply with all SIHC policies and procedures. One must have the ability to understand the implications and complexities of all compliance policies. Participation in all compliance training is mandatory, and generally have a heightened awareness of policies and regulations that are specific to one's department and position. All SIHC employees are expected to report violations or suspected violations of compliance policies or regulations.

Other: Applicants must successfully pass a pre-screening, including a tuberculin skin test or x-ray and a blood/urine drug screening test. Health must be adequate to perform all duties of the position. Applicants must complete SIHC Application and Authorization Form, both must be submitted to Human Resources prior to the close date indicated.

Indian Preference: In the filling of any SIHC job vacancy, preference may be given to qualified Native American Indians, pursuant to the Indian Preference Hiring Act, 25 USC 472, unless other laws require the filling of a vacancy without regard to Indian preference (e.g. Public Law (P.L.) 94-437, "Indian Health Care Improvement Act (IHCIA). To receive Indian preference for any SIHC position, the applicant must be enrolled, or be eligible for enrollment, as an American Indian with their Tribe, or must be certified as an American Indian from the designated Tribal Representative. Applicants claiming Indian preference must attach verification of their claim to the SIHC application, including Certification of form BIA-4432, which is available from the SIHC Human Resources Department. If verification is not or cannot be verified, the applicant will not receive Indian preference for purposes of the interview.