Billing Clerk

Job Description Billing Clerk Report to:

Finance Department:

Director of Reimbursements Position Summary:

Compiles service data, prepares invoices for claim statements, maintains accurate claim statement records and processes claims in a timely manner, as established by Agency protocol. Maintains accurate statistical data records involving client services provided, claims and accounts receivable. Responsible for timely response to payer information requests and Medicare Credit Balance Report submission.

Position Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Essential Duties and Responsibilities include the following. Other duties may be assigned.

Daily Duties:

Assumes the backup responsibilities for entering visit slips in computer system each day, as received. Posts all distributed medical supplies to each client's account. Follows up on claims that have been submitted for payment for more than sixty days, for all payers. Answers questions for payers regarding submitted claims. Files all pre-billing worksheets and unpaid claims on the pre-billing worksheet. Prepares and submits adjustments to Medicare, third party payers and clients, as required.

Weekly Duties:

Develops and prints a working list of all patients with active visits during the specified period. Assures alt patient visits occurring during the specified period have plan of care (485's) and verbal orders signed by the physician prior to submitting claims. Prepares a working list of Medicare claims for electronic claim submission for the specified period. Prepares an Absent Data Report for the specified working list(s), connecting any absences noted on the report. Submits Medicare claim file via electronic media every other week, on Wednesday, unless approval for late submission obtained by supervisor. Print and file copies of UB-92's in a file folder for unpaid Medicare claims. Verify receipt of electronically submitted claim batch files with Medicare. Private insurance monthly

Billing:

Develops and prints a working list of certifications and re-certifications occurring during the specified period. Assures all patients with active visits during the specified period have signed plan of cares (485's) and verbal orders signed by the physician prior to submitting claims. Separates various working lists by primary payer. Prepares a working list of non-Medicare claims for "hard-copy" claim submission. Prepares an Absent Data Report for the specified working list(s), connecting any absences noted on the report. Prints

UB-92 HCFA

1500 or client statements forms, as specified by payer requirements. Makes copies of all Plan of Care's, clinical care notes, physician order, and any required authorization letters for submission with claim. Submits claim to payer via certified mail, with return receipt requested. Files copies of UN-92's, HCFA 1500's and client statements in a file folder for unpaid claims.

Additional On-going Duties:

Performing computer data transfers daily. Posts all accounts receivable payments to the appropriate ledger accounts. Prepares requested documentation for all payers within requested time frame. Mails requested documentation via certified mail, with receipt requested. Submits information regarding all claim denials to immediate supervisor in a timely manner. Verify Medicare HIC numbers and all other insurance information and refer information to Agency staff. Assists other Agency staff members in developing reports from 'Prompt", as requested by the Chief Financial Officer, within the time frame specified. Completes additional projects as requested by the Chief Financial Officer, with the time frame specified.