Billing Clerk

Purpose:

• The Billing Clerk is responsible for a variety of billing tasks relating to the efficient provision of medical services at Western Wayne Family Health Centers (WWFHC). These activities include billing reports, encounter coding, claims submissions, error corrections, and other duties as assigned by th e Billing Manager. Dental responsibilities will be collecting, posting and managing account payments, submitting claim and following up with insurance companies and a variety of task that are assigned.

PART I: ESSENTIAL POSITION FUNCTION AND DUTIES

1. Prepares and submits clean claims to various insurance companies either electronically or by paper if needed.
2. Identifies and perform tasks within the EMR such as responding to patient cases.
3. Responds to requests for additional information, medical records, or other payer or legal correspondence.
4. Identifies and resolves patient billing complaints.
5. Reviews and reports status of delinquent accounts.
6. Performs accounts receivables function with patients by issuing outstanding balance invoices (when applicable).
7. Performs various collection actions including contacting patient by phone, correcting and resubmitting claims to
third party payors.
8. Process payments and adjustments from insurance companies or patients when applicable.
9. Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
10. Responsible for maintaining a current knowledge of coding and diagnostic procedures as well as being current
regarding legislative changes related to billing and office practices.
11. Corrects and checks all encounter coding, resubmitting claims when necessary.
12. Works with providers and consultants to resolve coding issues.
13. Prepares good faith estimates as required by WWFHC guidelines.
14. Reconciles all benefits claims and payments with third party payers.
15. Maintains accounts receivables aging analysis.
16. Performs other functions as assigned.

PART II: CLINIC WIDE RESPONSIBILITIES

1. Customer Relations:
a. Treats guests, patients, physicians, and other employees with care, courtesy, and respect.
b. Responds quickly and appropriately to customer request.
c. Looks for and suggests ways to better meet customer needs.
d. Answers clinic communications systems promptly with courtesy and respect.

2. Teamwork:
a. Works cooperatively within own department and other areas.
b. Willingly accepts additional responsibility – tries to make other’s job easier.
c. Responds quickly to request for assistance.
d. Required to work closely with patients and associates.
e. Interacts with other departments on problem issues.
f. Accepts feedback from patients, visitors, clinic employees, physicians and general public.

3. Continuous Improvement:
a. Continuously looks for and suggests ways to improve.
b. Effectively completes assignment to achieve the greatest benefits at acceptable cost.
c. Implements improvements as appropriate.
d. Demonstrates interest in own growth and development by:
(1) Periodically evaluating own performance.
(2) Demonstrating an awareness of personal abilities and limitations.
(3) Independently seeking means to make improvements.
(4) Attends and participates in in-services and continuing education programs
(5) Attends departmental meetings.

4. Communications:
a. Keeps appropriate people informed.

b. Speaks and writes clearly, concisely, and appropriately for need.
c. Listens carefully.
d. Communicates tactfully.
e. Understands that all confidentiality and privacy considerations are respected and fostered at work and off
duty.

5. Self –Management:
a. Presents a positive image of WWFHC at all times.
b. Carries out assignments with little need for direction.
c. Timeliness.
d. Maintains confidentiality.
e. Provides proper notification of absence and tardiness.
f. Works weekends and shifts when necessary.

Onsite In-Person Role 

PART III: EDUCATION, EXPERIENCE

Education:

• 1. Education: Completion of a Billing and Coding program.
  2. Experience: One (1) year of experience in medical/dental business office with primary focus on
  insurance billing and coding practices. One (1) year of medical coding experience.

PART IV: KNOWLEDGE, SKILLS AND ABILITIES 

1. 1. Preferred knowledge of FQHC billing or multi-specialties.
   2. Preferred knowledge of Athena or IDENTAL Soft.
   3. Proficiency using EMR system and Microsoft Office.
   4. Knowledge of basic billing, coding and account management techniques.
   5. Skilled with working in a complex work environment.
   6. Ability to maintain confidentiality at all times and maintain organizationally appropriate relationships.
   7. Knowledge of organization policies and procedures.
   8. Knowledge of computer, systems, and medical or dental billing applications.
   9. Skilled in exercising initiative, appropriate judgment, problem-solving and decision making.
   10. Skilled in developing and maintaining effective relationships with internal and external customers.