Seminole Hospital District | Health Claims Clerk

19 May Health Claims Clerk

Posted at 09:30h in Jobs by Crystal Tyson

This position is a full-time, goal-oriented, revenue-driven, highly accurate and motivated Health Claims Clerk.

Pay Scale: Non Exempt
Department: Medical Records
Reports To: Director of Revenue Cycle
Location: Seminole Hospital District

Complete coding within a timely manner
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
Work medical record billing report daily
Process, manage and follow up on claims to ensure timely resolution
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
Process medical records request in a timely manner
Send necessary appeals when warranted
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.

Assign work; plan and manage priorities.
Medical coding as assigned by Director.
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.

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

Proficient use of computers including Microsoft Office 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

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