Billing Clerk (Rock Cave) bei COMMUNITY CARE OF WEST VIRGINIA INC

Description

Job Objective: Bills insurance companies for all office-based medical provider bills. The clerk pursues the collection of all claims until insurance companies make payment. Performs other work associated with the billing process, including billing and collections of self-pay accounts.

Responsibilities and Essential Duties:
• Prepares and submits office-based provider claims to third-party insurance carriers either electronically or by hard copy billing.
• Posts all receipts from patients to proper patient accounts
• Secures the need for medical documentation required or requested by their party insurance companies.
• Process patient refunds and complete proper paperwork for payment of refund to either patient or insurance company.
• Follows up with third-party insurance carriers on unpaid claims until claims are paid, or only self-pay balance remains.
• Send patient accounts to a collection agency, if needed.
• Processes rejections by making accounts private, generating letters of rejection to patients, correcting any billing error, and resubmitting claims to third-party insurance carriers.
• Works with medical providers or medical record staff to ensure that correct diagnosis/procedures are reported to third-party insurance carriers.
• Regularly work with patient navigators to ensure correct patient/ insurance information is obtained.
• Makes accounts private and notify patients when claims have not been paid or rejected in established accounts receivable policy.
• Keeps updated on all billing and benefit changes for third-party insurance carriers.
• Posts third-party insurance remittance vouchers.
• Monitors claims for missing information, authorization/control numbers.
• Maintains confidentiality of all information.
• Completes work within authorized time to assure compliance with departmental standards.
• Keeps updated on third-party billing requirements and changes for insurance types within their area of responsibility.
• Demonstrates knowledge of, and supports, office mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
• Performs other duties as required

Teamwork:
• Assist in the orientation/training of new Team Members.
• Consistently work in a positive and cooperative manner with fellow Team Members.
• Assist other Team Members in the performance of their assignments.
• Seek out opportunities to help rather than waiting to be asked.
• Consider the impact of your actions on Team Members throughout the Organization.
• Recognize the need for variations in staffing and volunteer to fill open shifts when possible.
• Take direction and initiate actions (cross/additional training) to allow the assumption of cross-functional duties.
• Demonstrate flexibility to perform duties wherever volume deems it necessary within the organization.

Problem Solving:
• Demonstrate sound judgment by taking appropriate actions regarding questionable findings or concerns.
• Investigate and follow through on unusual orders or requests for service or information.
• Follow proper reporting procedures for actual or potential accidents and/or incidents so follow-up and/or prevention can occur.
• Record/report the need for service maintenance or repair of equipment and remove any faulty equipment from service.
• Consistently evaluate work and determine if further steps are needed to meet management expectations.
• Take the initiative to do or redo inadequate or incomplete work, even if it is not yours.
• Ensure compliance with regulatory standards.

Productivity/ Efficiency:
• Consistently demonstrate the ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.
• Minimize non-productive time and fill slow periods with activities that will enable you to prepare to meet the System's future needs (education, organizing, housekeeping, assisting others).
• Organize job functions and work areas to be able to complete varied assignments within established time frames effectively.
• Consistently demonstrate the ability to take the initiative to make decisions/choices without direct supervision.

Adherence to Departmental Policies:
• Demonstrate knowledge and understanding of all policies and procedures and the ability to reference them from appropriate books and manuals.
• Comply with CCWV's Exposure Control Plan, which reflects OSHA Bloodborne Pathogens Standard to ensure a safe working environment for self and others.

Great Benefits

• Paid Time Off (PTO)

• Paid Holidays

• Extended Sick Pay (ESP)

• Medical Health Insurance and Prescription Coverage

• Basic Life Insurance for Employee and Family

• Short-Term Disability

• Long-Term Disability

• 401(k) Voluntary Contribution Plan

• Health Reimbursement Account

• Employee Elected Voluntary Coverage for Employee and Family

• Life Insurance, Dental, Vision, Flexible Spending Account, Dependent Spending Account

• Discounted undergraduate & graduate rates at West Virginia Wesleyan College for employee and family

Qualifications

Physical Demands/Work Environment:
• Intermittent physical activity including walking, standing, sitting, lifting.
• Must be able to sit for long periods of time.
• Must have visual and hearing acuity within normal range.
• Must have manual dexterity needed to operate computer and office equipment.
• Will require the ability to lift heavy boxes up to 25 pounds in weight.

Qualifications/Requirements/Skills:
• Ability to bill third-party insurance for facility and professional claims by hard copy and electronically is preferred. Knowledge of third-party billing requirements is also preferred.
• Must show maturity in dealing with fellow employees and patients. Good verbal and written communication skills are essential.
• Knowledgeable of provider credentialing is a plus.

Education/Training/Experience:
• Successful completion of high school or commercial coursework, including math, bookkeeping, and business. Post-high school courses in insurance billing, data processing, and medical terminology are preferred.
• One year prior experience is preferred in the billing of third-party insurance for facility and professional services required. Must be able to type 35 wpm and operate a personal computer.