Community Health Systems
SUMMARYUnder the general supervision of the Business Office Manager, the Billing Clerk is responsible for the following: prepare and post fee tickets for various sites and programs post and balance payments received; handle all incoming billing calls; work aging for various programs and payers; send patient statements; run month-end reports; submit third party claims electronically or manually; ensure that all Providers/Facilities are paneled with the various insurances and state programs; maintain current knowledge of CPT, HCPC and ICD-10 coding practices; maintain knowledge of all programs and payer source requirements and guidelines.It is the primary purpose of CHCCC to provide the highest quality of total care possible to the patient population it serves. Such a level of quality depends ultimately on the staff's desire and ability to work together, individually, and as a team. The employee is expected to be professional, punctual, maintain regular attendance, cooperative, organized, and enthusiastic at all times.ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned with or without notice.Billing Clerk I:Post daily fee tickets and/or incoming mail (charges, payments, adjustments) for various sites and programs electronically/manually. Review fee tickets for accuracy of diagnosis, CPT and HCPC coding. Check for covered services per payer source to avoid claim denials. Run daily posting and transaction reports to balance total charge, payments and adjustments. Check eligibility for third party insurances. Run missing fee ticket report to ensure that all fee tickets have been posted or voided. Assist patients/employees with billing/ insurance questions. Batch and balance third party RA's and distribute to billing clerks for correction when needed. Check CHDP claims for accuracy. Generate rebilling and unbilled claims reports. Print and submit billing claims to all third-party insurances manually. Make necessary corrections to claims that have errors.Billing Clerk II:Covers Billing Clerk I duties when on vacation or out sick. Balance daily cash reconciliation sheet to ensure that all cash posted either by fee tickets, incoming mail or electronic cash receipts are balanced monthly. Prepare cash reconciliation Excel spread sheet for finance monthly. Submit third party claims electronically and/or manually. Check claims error report and make necessary corrections for re- submissions. Train employees on various payers and programs. Work accounts receivable aging for third party insurance, sliding fee and private pay. Work denials from third party remittance advice/explanations of benefits. Run various month-end reports to balance monthly billing activities.Billing Clerk III:Has Billing Clerk I and II knowledge and covers when clerks are on vacation or out sick. Update and maintain Nextgen/Athena EPM file maintenance, BBP and libraries. Process EDI files for specialty services and work claims edits reports. Assist billing staff with coding, posting and Nextgen EPM questions. Update electronic billing format for Medi-cal/Medicare. Ensure that specialty services (inpatient and surgeries) and modifiers are coded correctly to receive allowed reimbursement with no reductions.Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations.Maintains and adheres to confidentiality and privileged communications (patient, employee and corporation).Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations.Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served (infants, pediatrics, adolescents, adults or geriatrics).Demonstrates knowledge of domestic violence, child and dependent abuse protocols.Demonstrates culturally sensitivity and competence with patients.Maintains and adheres to HIPAA, employee confidentiality, and privileged communications (patient, employee, and corporation).SUPERVISORY RESPONSIBILITIESNone.QUALIFICATIONSTo 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.EDUCATION and/or EXPERIENCEBilling Clerk I: High school diploma or General Education Degree (GED). Two years experience in medical billing and collections. Must be able to establish and maintain effective working relationship with internal and external customers. Must be organized. Computer literacy required.Billing Clerk II: Same as Billing Clerk I, plus experience with billing of inpatient services, procedures and surgeries. Knowledge of all billing modifiers and CPT, ICD-10 and HCPC specialty coding.Billing Clerk III: Same as Billing Clerk II, plus experience with report generation. Ability to work all payer source aging reports. Help with new staff training. Set up and update Nextgen practice management system with new providers, insurance information and system master files. Panel all providers with the various insurance companies. Transmit claims electronically to various payers.LANGUAGE SKILLSAbility to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.MATHEMATICAL SKILLSAbility to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.REASONING ABILITYAbility to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.CERTIFICATES, LICENSES, REGISTRATIONSPossession of current, valid California Driver's License (Class C) and CPR (BLS-C) card.Annual health examination, annual TB skin test clearance or bi-annual chest x-ray, if required, MMR immunity, and HBV optional, required.PHYSICAL DEMANDSThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to sit. The employee is occasionally required to stand and walk. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.WORK ENVIRONMENTThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is frequently exposed to moving mechanical parts. The employee is occasionally exposed to risk of electrical shock. The noise level in the work environment is usually moderate.Must be willing to have a flexible work schedule that may include evenings/weekends, and travel as needed.