Biller/Office Clerk

Position Purpose: Provides support to the Facility by performing specific or various business office functions as assigned. These functions include (but are not limited to): Medical Records, Admissions, Intake, Billing, Collections, Insurance Verification, Payment Transaction Posting, Agency Accounts, and other duties as assigned.

Job Requirements:

Primary Job Duty - Billing:
1. Obtains the Daily Summary Report (DSR)
2. Pulls all the unbilled Charts listed on the DSR
3. Ensures the authorization from the payer has the correct Codes listed on the DSR. Obtain a corrected authorization as needed.
4. Pended accounts - Enter a note in patients' pending accounts if coding is incomplete.
5. Inputs CPT/ICD9/HCPC information from DSR into the patient accounting system for all "complete and ready to bill" cases.
6. Uses the correct transaction code for each account based on financial class.
7. Verifies all contract amounts are populated and record the total charge amount on DSR for balancing.
8. Sequences codes by the contract allowable, with the highest allowable first according to the contract.
9. Completes a Charge Description Master (CDM) form for any code without a listed fee or for codes with a billed charge that is LESS than the contracted amount in the patient accounting system and submit it to the Business Office Manager.
10. Balances accounting system reports to coding sheet before posting.

Billing/Claims Submission:
11. Claims will be sent to ECS and the payer, as required.
12. Prints UB/HCFAs as required for paper claims and submit them to the payer with the required attachments.
13. Submits ECS claims to payers and fax attachments to payers, as required.
14. Resolves claim rejections by monitoring ECS reports daily.
15. Sends daily claims to secondary payer daily.

Pended/Incomplete Case Review:
16. Reviews pended case reports weekly and determines the action needed to resolve.
17. Follows up on all canceled cases to determine if they are eligible for charge.
18. Forwards cancellation sheet to the encoder.
19. Assigns preliminary CPT codes to all pended accounts at month end and makes a notation in the patient's account.
20. Maintains basic knowledge of medical terminology.
21. Possesses knowledge of health insurance billing.
22. Specializes in typing, word processing, spreadsheet, and computer billing systems.
23. Delivers accurate judgment, especially in handling insurance claims and patient accounts.
24. Adapts and willing coordinates with and participate in, when necessary, all other aspects of the Business Office.
25. Possesses a strong initiative to get daily work finished and processed.
26. Effectively communicates with patients, physicians, and other staff members.
27. Continuously is polite, understanding, and sympathetic toward the patients, physicians, and others.
28. Follows the attendance policy to maintain regular attendance.
29. Keeps all information confidential.