Pioneers Memorial Healthcare District

About Pioneers Memorial Healthcare District

POSITION SUMMARY: The Insurance Biller/Follow-Up Clerk is responsible for the timely and accurate insurance claims processing. Ensures accurate and complete information appears on the UB-92 in the electronic billing system. Forwards bill to the proper payer within the time constraints of the department. In addition, the clerk is responsible for the timely follow-up and account resolution of assigned insurance claims, communicating with patients and insurance carriers, while safeguarding the public relations of the hospital by using consistent professional conduct. ESSENTIAL FUNCTIONS: Prepares all IP and OP insurance claims according to the proper method requested by each individual insurance company for primary and secondary insurance. Maintains productivity in line with department standards. Prepares prints of UB92s for Follow-Up personnel upon request and resubmit billings when applicable. Responsible for the correctness of all information when filing insurance claim. Responsible for written follow-up on assigned insurance claims according to set department policy and procedure. Provides quality control feedback as it relates to the quality, accuracy, and timeliness of other departments as it relates to the billing process and minimize delays on reimbursement. Processes patient and third party insurance credits and refunds. Processes mail and correspondence and documents into Affinity System. Processes appropriate write-offs, adjustments, account reclassifications in accordance with the Patient Accounting Department Policy and Procedure: Write-Offs and Adjustments. Assists on inquiry phone calls from and to patients and third party payers. Keeps accurate records on all patients, under scope of responsibility, which includes keeping accurate information on account activity; provides appropriate file documentation as needed to maintain accurate records on patients’ account financial status. Responsible for being familiar with regulatory changes issued by intermediaries and insurance companies to determine how charges could impact claims processing and communicates with Coordinators such changes. Demonstrates a thorough knowledge and understanding of billing and follow-up policies and procedures in performing job duties and instructing patients and hospital personnel. Routinely uses Patient Accounting Policy and Procedure manual and other reference materials as necessary to ensure the proper course of action in insurance follow-up and collection. Responsible for providing feedback to the Department Manager as to the accuracy of the HIS Affinity, DSG billing system, Medical Record’s 3M coding system, based on accurate coding as it impacts billing and reimbursement. Prints daily report for Coordinators on system uploads and downloads of accounts to be billed. Responsible for reporting the status of all accounts under scope of responsibility. This includes the timely response to all requests and inquiries by the Department Coordinators or Director. Performs general clerical functions: answers telephones, types, compiles necessary reports and maintains filing systems for information needed to complete work within the department. Responsible for providing weekly Insurance Production Report reflecting all activity for the week. OTHER RESPONSIBILITIES: Utilizes the HIS Affinity System to its full capacity by CRT. Continues to grow in the user of the computer system as its capabilities expand. Consistently responds to requests from patients for account charge settlement and related information in a timely and courteous manner. Performs similar job related duties as assigned. SUPERVISORY RESPONSIBILITIES: None. EDUCATION, KNOWLEDGE, SKILLS, ABILITIES, EXPERIENCE, AND SKILLS: High school education or equivalent. Experience of three years of specialized billing and knowledge of medical terminology. Mathematical ability required to review statistical data on various financial records. 10 key adding machine and typing experience is required. Accuracy is more important than speed. Knowledge of filing systems and copy machines. LICENSES AND CERTIFICATIONS: None. AGE OF POPULATION SERVED: Newborn  Infant/Pediatric  Adolescent  Adult  Geriatric  All  PHYSICAL REQUIREMENTS: see attached. Sits, stands, bends, lifts, and moves intermittently during working hours. Visual and hearing acuity pertinent to communicating with customers. I have read the above job description and fully understand the requirements set forth therein. I agree to abide by the requirements set forth and will perform all duties and responsibilities.

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Company Info

Company Type: Hospital

Company Size: 501 - 1000

Revenue: 100 - 500 million (USD)

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Job Ads found: 198

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