Billing Clerk

Job Summary:

Under general supervision, performs billing, claims processing, collections, reimbursement, account reconciliation, and customer service functions in support of the organization's revenue cycle operations. Responsible for preparing and submitting claims, resolving billing discrepancies, maintaining financial records, processing payments, monitoring accounts receivable activity, and ensuring compliance with payer, regulatory, and organizational requirements. May provide training, guidance, and technical assistance to less experienced staff.

Essential Functions:

• Obtains and verifies patient demographic, insurance, financial, and eligibility information.
• Interviews patients, responsible parties, and external agencies to obtain billing and payment information.
• Determines financial responsibility according to agency policies and payer requirements.
• Verifies insurance coverage, benefits eligibility, and reimbursement requirements.
• Prepares, reviews, and submits billing claims to Medicaid, Medicare, commercial insurance carriers, third-party payors, and responsible parties.
• Reviews claims, patient accounts, and supporting documentation for completeness and accuracy.
• Applies appropriate billing codes and corrects discrepancies as necessary.
• Submits claims accurately and within required timelines.
• Monitors outstanding claims, reimbursement activity, and accounts receivable balances.
• Researches, analyzes, and resolves denied, underpaid, overpaid, missing, or delayed claims.
• Processes corrected claims, appeals, adjustments, and supporting documentation.
• Communicates with insurance companies, governmental payors, providers, and patients regarding billing issues.
• Collects payments and establishes payment arrangements in accordance with organizational policies.
• Posts payments, adjustments, refunds, and billing transactions accurately.
• Balances receipts, cash journals, account records, and billing transactions.
• Prepares and distributes billing statements, delinquent notices, and related correspondence.
• Coordinates collection activities and supports bad debt and write-off review processes.
• Maintains billing records, patient account files, and financial documentation.
• Compiles billing, claims, and reimbursement data for reporting purposes.
• Prepares routine operational, reimbursement, collection, and billing reports.
• Responds to billing inquiries from consumers, staff, providers, and external agencies.
• Maintains confidentiality of financial, billing, and protected health information.
• May provide technical guidance, training, and support to billing personnel.
• Participates in departmental meetings, training activities, and process improvement initiatives.
• Performs work in accordance with agency policies, procedures, regulations, and revenue cycle standards.

Required Knowledge & Skills:

• Knowledge of healthcare billing, collections, reimbursement, and revenue cycle operations.
• Knowledge of Medicaid, Medicare, commercial insurance, and third-party payer requirements.
• Knowledge of accounts receivable processes and claims management practices.
• Knowledge of healthcare confidentiality laws and privacy requirements.
• Knowledge of billing record maintenance, reporting, and reconciliation procedures.
• Knowledge of office administration, clerical practices, and customer service principles.
• Ability to interpret reimbursement guidelines, insurance requirements, and agency procedures.
• Ability to identify, research, and resolve billing and claims discrepancies.
• Ability to reconcile account balances and financial records accurately.
• Ability to prepare reports and maintain detailed documentation.
• Ability to communicate professionally and effectively with consumers, staff, and external agencies.
• Ability to organize and prioritize work assignments.
• Ability to maintain confidentiality and exercise sound judgment.
• Ability to perform accurate data entry and maintain accurate financial records.
• Proficiency with Microsoft Office applications, billing systems, electronic health records, and related software.

Primary Responsibilities, but not limited to:

• Claims preparation and submission.
• Accounts receivable management.
• Payment posting and account reconciliation.
• Collections and reimbursement follow-up.
• Insurance verification and eligibility determination.
• Billing discrepancy research and resolution.
• Patient account maintenance.
• Revenue cycle reporting and documentation.
• Customer service and financial communication.
• Revenue cycle process improvement support.

Competencies:

• Communication
• Customer/Client Focus
• Accountability/Responsibility
• Attention to Detail
• Problem Solving/Analysis
• Ethical Conduct
• Time Management
• Professionalism
• Data Accuracy
• Job Knowledge
• Teamwork
• Confidentiality

Required Education & Experience:

• High School Diploma or GED.
• One (1) year of experience in healthcare billing, medical office administration, accounts receivable, collections, bookkeeping, insurance claims processing, customer service, or related administrative functions preferred.
• Post-secondary coursework in accounting, finance, business administration, healthcare administration, or related fields preferred.
• Experience with Medicaid, Medicare, commercial insurance billing, or behavioral healthcare revenue cycle operations preferred.

Upon appointment to the position, the employee assumes responsibility for meeting and maintaining all minimum qualification requirements, including applicable certifications, licenses, continuing education, competency validations, and mandatory annual or recurrent training. Failure to maintain such requirements may affect eligibility to perform assigned duties.

Supervisory Responsibilities:

None. May provide lead work direction, training, guidance, and technical support to other billing personnel as assigned.

Work Environment:

This position operates in a professional office environment and routinely utilizes computers, telephones, electronic health records, billing systems, printers, scanners, filing systems, and standard office equipment. Frequent interaction with consumers, staff, providers, insurance representatives, and external agencies is required.

Physical Demands:

• Requires prolonged periods of sitting and working at a computer.
• Requires frequent verbal communication and hearing.
• Requires manual dexterity to operate computers, calculators, telephones, and office equipment.
• May occasionally lift, carry, file, and retrieve records and office materials.
• May bend, reach, stoop, and stand while performing filing and administrative activities.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Gateway CSB promotes a drug-free and alcohol-free work environment through mandatory pre-employment drug testing.

Terms & Conditions:

• Reports to work when scheduled and begins and ends work as expected.
• Reports anticipated tardiness or absence to the supervisor.
• Observes policies regarding meal and break periods.
• Uses work time appropriately and efficiently.
• Requests and utilizes leave appropriately.
• Maintains a professional appearance in accordance with site dress code requirements.
• Observes health, safety, and sanitation policies.
• Performs work according to all applicable rules, regulations, policies, and guidelines.
• Ensures compliance with required training, including new employee orientation.
• Does not engage in activities other than official business during work hours.
• Does not report to work under the influence of alcohol or drugs.
• Adheres to Gateway’s Standards of Conduct 3.13 and Employee Ethics 3.23.
• May be required to remain at or return to work during agency incidents or emergencies and may work non-traditional schedules as necessary to support agency operations.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee in this job. Duties, responsibilities and activities may change at any time with or without notice.

Employee signature below constitutes employee’s understanding of the requirements, essential functions and duties of the position.