The Insurance / Biller Clerk reflects the mission, vision, and values of adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
Responsible for completing data entry assignments. Collects documents and reports and enters appropriate information in the hospital system. Works closely to support Patient Financial Service staff.
• Provides accurate information and timely updates to patients and customers. • Participates in efforts to reduce costs, streamline work processes, improve and grow services we provide.• Proficient in the retrieval and processing of documents. • Demonstrates the ability to enter clear, accurate and complete collection notes.• Demonstrates understanding of how to initiate the IDPA batch claim status process and review output reports for consistency. • Understands the different insurance buckets in the hospital operation system and applies adjustments to the appropriate insurance/payor column.• Reviews government payers supplemental and patient liability reports effectively to ensure the amount identified is spenddown, ABN or non-covered services and are handled according to department policy and procedure.• Understands the impact and importance of Medicare bad-debt accounts on the hospital's accounts receive. Is proficient in obtaining all information necessary to effectively classifying accounts within Medicare guidelines. • Responsible for logging and maintaining the Medicare Bad Debt logs pertaining to Medicaid balances for the cost report. • Follows appropriate practices when revising an account from one financial class to another. Applies adjustment, action and denial codes according to policies and procedures.• Completes special assignments and projects with minimal supervision and consistently meets targets, timetables and deadlines.• Contributes to opportunities and processes for continuous improvement.• Collects registration, charging, coding, billing and utilization review errors and reports to the appropriate department according to PFS policy.• Develops and maintains relevant training material for Patient Access staff related to third party billing regulations.• Demonstrates knowledge & compliance with insurance, local, state, federal and contract regulations related to hospital billing.• Monitors credit balances consistently in order to meet department standards requiring account to be resolved within 30 business days. • Effectively refers credit balances to the appropriate PFS personal within two business days.• Demonstrates knowledge and understanding of CDH's managed care contracts. Effectively refers discrepancy to the appropriate PFS personal within two business days
Experience and Skills Required
Two – Four years’ experience in clerical support and significant data entry within the Healthcare Industry.
Skills required: • Excellent computer skills with strong knowledge of Microsoft Office suite• Works well in a fast-paced environment. • Excellent communication skills• Customer Service orientation• Ability to organize and manage multiple assignments• Strong organizational, communication and interpersonal skills. • Ability to follow directions independently.• Ability to participate and collaborate as a team player, working in a time-pressured environment.• Fluent English speaker. Knowledge of Arabic will be an advantage although not essential.
Minimum Qualifications: Diploma or equivalent.