AR/Coding Clerk

This position is a full-time, goal-oriented, revenue-driven, highly accurate, and motivated AR/Coding Clerk.

Pay Scale: Full-Time, Non Exempt

Reports To: Director of Revenue Cycle

Location: Seminole Hospital District

Responsibilities

  • Communicate with patients, government agencies, and third-party payers to gather, process and record information.
  • Possess strong customer service skills to communicate with departments and payers to optimize revenue based upon claim appeals for expected payer reimbursement
  • Review both paid and unpaid claims, obtaining necessary information to follow up to resolve reimbursements
  • Assist in more complex claims as well as utilizing monthly aging reports to help obtain maximum reimbursement
  • Run weekly late charge reports and hold department managers accountable for late charges
  • Assist with daily closing of charge days, AR days and assist with closing month in a timely manner
  • Secondary duties include but are not limited to data entry of all patient demographic, guarantor and insurance information, posting procedures and insurance/patient payments, balance to daily deposits Observe and comply with all HIPAA policies and procedures in accordance with PHI access level and immediately report any improper or questionable use and/or disclosures of PHI to the HIPAA compliance officer through appropriate channels.
  • Secondary duties include but are not limited to data entry of all patient demographic, guarantor and insurance information, posting procedures and insurance/patient payments, balance to daily deposits 
  • Observe and comply with all HIPAA policies and procedures in accordance with PHI access level and immediately report any improper or questionable use and/or disclosures of PHI to the HIPAA compliance officer through appropriate channels.

Essential Functions

  • Assign work; plan and manage priorities.
  • Resolve insurance claim rejections/denials, and non-payment of claims by payors.
  • Identify trends in billing and follow-up, maintaining working knowledge of state and federal billing guidelines in order to identify ways in which our patients can expedite resolution of insurance accounts and identify delays in processing.
  • Responsible for drafting effective appeals to insurance companies for reimbursement of monies owed.
  • Responsible for maintaining daily account, follow-up work lists within department.
  • Ensure compliance when processing claims. in accordance with contracts and policies; as well as to adjudicate claims as appropriate.
  • Responsible for identifying, researching, and resolving credit balances, missing payments and unposted cash as it pertains to billing account follow-up.
  • Process, and maintain within expectation, all correspondence received from patients and insurance companies as it pertains to correct and timely billing of claims, and receipt of payment.
  • Responsible for handling patient disputes and submission of issues to coding for review to ensure organizational and revenue cycle processes are followed.
  • Communicates appropriately with insurance companies, patients, co-workers and supervisors.
  • Perform other duties as assigned.

Education and Experience Requirements

  • Medical billing Certificate Preferred
  • Minimum of three years’ experience in a billing or insurance account follow-up capacity is required. Formal training or college coursework from a medical coding accredited school, specific to medical billing in lieu of experience may be considered.
  • Medical terminology experience required.
  • Knowledge of insurance processes and billing guidelines regulations required.
  • Coding knowledge preferred.
  • Epic experience, specifically CPSI Billing Module experience preferred

Skill Requirements

  • Proficient use of computers including Microsoft Office 2010 applications.
  • Skilled in 10-key by touch and keyboarding.
  • Ability to operate general office equipment
  • Exceptional verbal and written communication skills
  • Excellent attention to detail and ability to multi-task
  • Ability to work with minimal supervision, independently, as well as in a collaborative team setting.
  • Strong organizational skills with the ability to prioritize and meet deadlines.
  • Requires knowledge of Commercial and/or Government Payors.
  • Ability to identify, research, and resolve credit balances, missing payments and un-posted cash as it pertains to billing account follow-up.

Supervisory Responsibility: 

None

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

  • Intermittent periods of sitting and standing
  • Lifting/carrying >= 40 lbs.
  • Periods of stooping/kneeling
  • Occasional periods of high stress levels

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