Clerk, Billing

Lake Cumberland Regional Hospital

Who We Are:

People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Lake Cumberland Regional Hospital is a modern, state-of-the-art 295-bed acute care facility, offering an advanced neurosurgery program with Spine Center accreditation amongst other specialty services.

Where We Are:

The City of Somerset blends southern hospitality with abundant recreational opportunities including a 65,000-acre lake with 1,200 miles of shoreline. Somerset is host to nationally recognized, high quality performing and visual arts, concerts and other special events to the community.

Why Choose Us:

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off / Extended Illness Bank package for full-time employees
• Employee Assistance Program – mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• Professional Development and Growth Opportunities
• And much more…

Position Summary:

A Billing Clerk is responsible for billing process through the preparation and transmittal of accurate and complete bills in a timely manner to Medicare, Medicaid and other third-party payers.

Reports to: Director of Business Office

FLSA: Non-exempt

Job Requirements:

Minimum Education:

• High School diploma or equivalent

• Preferred: Two years of college coursework completed or equivalent work experience

Required Skills:

• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Minimum Work Experience:

• Preferred: Previous insurance billing experience or analytical experience determining priorities, where options are limited.

Essential Functions
Follows established policies and procedures. objectives, safety standards, and sensitivity to confidential information.
Process 100% of accepted claims within one working day of receipt.
Edit claims to completion, exhausting all resources to meet established guidelines.
Enter 100% documentation immediately upon receipt, keeping account information current and accurate.
Update billing system with demographic and/or insurance revisions within one working day of receipt.
Submit daily to manager those claims requiring additional information from Admitting/Registration staff.
Initiate follow up to third party payers no later than 15 days from final bill.
Work accounts to completion to ensure adjudication within 90 days from bill.
Actively follow up on all rejected and unpaid claims.
Obtain and/or supply payers with necessary information and/or documentation to expedite payment in accordance with payer guidelines.
Maintain current knowledge of CPT-HCPCS and ICD- 10 coding in accordance with third party payer guidelines for UB94 and HCFA 1500 claims.
Review accounts for accuracy of patient balances and insurance portions due, to ensure correct statements are mailed.
Maintain knowledge of payer contracts and reimbursement methodologist to insure correct payment and patient portion due.
Review and follow up on any charges credited or debited on patient accounts in accordance with established guidelines.
Follow up on denied, rejected and/or pending claims via remittance advice, Medicare FSS and other electronic systems within two working days or receipt.
Maintain reliable comprehensive cash controls to ensure timely and accurate ash applications to patient accounts.
Apply payments, calculate, process and generate adjustments not completed by the electronic remittance process within one working day or receipt.
Prepare daily reconciliation of cash and adjustment posting and forward a copy to the accounting department.
Review and research credit balances and resolve within five (5) working days.
Resolve all incoming no payment correspondence within five (5) working days.
Remain knowledgeable in the operation of the electronic remittance system to facilitate use when needed.
Make referrals of accounts to appropriate department, with a high level of accuracy, for payment offsets and appeals.
Keep manager appropriately informed of problems/issues or needs of the department.
Guard the confidentiality of patient record and report any breach of confidentiality to the manager.
Assist auditors with requested information for review of accounts and process corrected claims as necessary.
Notify department manager of absence or tardy, giving sufficient notice to provide coverage for the work area.
Specific duties (may vary daily) to be performed will be assigned by the manager depending upon the needs and requirements of the department and hospital to ensure all individuals are crossed trained in each area of responsibility.
Interacts with Patient Account Manager and/or Benefits Advisor related to patients with limited or no insurance coverage, personal portion payment and deductibles owed; and follows up with patient regarding insurance problems via phone or mail.
Demonstrates professional, courteous, caring telephone etiquette.
Retains business office records in readily retrievable fashion.
Maintains clean claims submission to 80% or better.
Maintains confidentiality in accordance with HIPAA regulations.
Performs other related duties as assigned or requested.

EEOC Statement

Lake Cumberland Regional Hospital is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.