HEALTH DEPARTMENT - ACCOUNT CLERK III

Important! To apply you must submit a Shawnee County application at https://jobs.sncoapps.us Only applications received through the County website will be considered.

SHAWNEE COUNTY, KANSAS POSITION DESCRIPTION

Under general supervision, this position maintains departmental accounting records in the Billing Office within the Shawnee County Health Department. This position is responsible for the billing of claims, the receipt of remittance advice and payments on accounts. Performs other duties as required. This position is supervised by the Medical Accounts Receivable Manager.

WORK PERFORMED 40

% Medical Claims Processing. Responsible for the submission of timely and accurate electronic and paper claims to government programs, and primary, secondary, and tertiary insurance companies. Creates billing files and reviews each claim within the billing report for correct insurance, Current Procedural Terminology (CPT) codes, International Classification of Diseases (ICD)-10 codes and units of services as required by third party payor. Creates and submits the claim file to the claims clearinghouse for the preparing and sending of claim files to government programs and insurance companies. Saves and analyzes electronic data interchange (EDI) claim submission reports, file received reports and electronically formatted claim files. Regularly analyzes consumer account information and scanned documentation for accuracy. 20% Accounts Receivable and Claims Management. Responsible for appropriate follow up on all accounts pending payment, up to resolution, which includes working monthly accounts receivable reports, performing corrections and resubmitting claims to payor, coordinating refunds, resubmissions, and adjusting claims. This position must file claim denial appeals when necessary. Responsible for identifying periodic claim denials and researching resolutions. Determines whether denials are an internal/system coding issue or if it is a payor system issue. This requires analyzing previous claims, Remittance Advices (RAs) and other claim reports. Identifies possible patient management system issues, accesses payer claim portals, and contacts customer service. Follow up on denial resolution is required. Responsible for learning and use of payor websites for referencing claims, staying current on coverage and reimbursement guidelines, and to obtain needed forms to process claim reconsiderations and payment recovery. Learns and uses other websites and systems as necessary. Performs regular billing audits and manages accounts receivable reports. 20% Posting Payments. Processes payments and refunds from government programs, insurance companies/payor and consumers. Review Remittance Advices (RAs) for incorrect reimbursement of services. Must be able to read and understand all payor RAs, regardless of format. Must learn and understand the use of claim adjustment codes, Remittance Advice Reason Codes (RARC), and Claim Adjustment Reason Codes (CARC). 15% Consumer Statements and Collections. Regularly reviews consumer accounts for accuracy of services being billed and insurance eligibility. Reviews accounts for non-payment and determines if they should be sent to the collection agency. Responsible for statement preparation and mailing. 5% Clerical Duties and Customer Service. Provides the highest level of customer service to a wide variety of internal and external consumers. Answers consumer's billing questions and works with consumers on payment arrangements. Works with government programs, insurance companies, payors and other vendors to resolve claim and billing issues. Must effectively and efficiently present information and respond to questions from managers, staff, consumers, general public, and payors. Performs other duties as assigned.

KNOWLEDGE, ABILITIES AND SKILLS

Knowledge of:

• General office machines and modern office practices.
• The English language, spelling, grammar and arithmetic computations.
• The operation and minor maintenance of various office equipment.
• Basic accounting principles and techniques.
• Generally Accepted Accounting Principles.
• Medicare, Medicaid, and third party billing policies and procedures.

Ability to:

• Interpret and apply Federal, State and County laws, resolutions, rules and regulations.
• Communicate effectively, both orally and in writing, using the English language.
• Follow oral and written instructions.
• Detect and reconcile discrepancies in financial records.
• Operate a variety of office equipment.
• Learn and understand the application of CPT, ICD-10 and Healthcare Common Procedure Coding System (HCPCS) standardized coding and American National Standards Institute (ANSI)

RARC/CARC

codes.

Skill in:

• The use of basic arithmetic including addition, subtraction, multiplication and division.
• The use of computer software and applications.
• The use of cash handling techniques.

MINIMUM QUALIFICATIONS

High School Diploma or GED Certificate. Two (2) years of experience in the balancing of accounts or two (2) years of experience in the Account Clerk II classification. Six (6) semester hours of college course work from an accredited college or university or one hundred eighty (180) clock hours from an accredited vocational school in financial accounting, banking or closely related field. One (1) year of experience in the balancing of accounts may be substituted for the required education. Required to type twenty-five (25) words per minute. Required to achieve 7,000 keystrokes per hour. No felony convictions. Valid Driver's License and able to operate County-owned vehicle (HR2013-2). Important! To apply you must submit a Shawnee County application at https://jobs.sncoapps.us Only applications received through the County website will be considered.

SHAWNEE COUNTY, KANSAS

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