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Spring Branch Community Health Center - Insurance Clerk

Spring Branch Community Health Center - Insurance Clerk

Spring Branch Community Health Center - Insurance Clerk

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Spring Branch Community Health Center
Job Description
Insurance Clerk 
 
 
SUMMARY:
 
Responsible for managing denied patient insurance claims and pursuing payment for those claims.  Responsible for monitoring the patient insurance accounts receivables aging reports and using them to identify accounts requiring attention. Responsible for follow-up on outstanding and delinquent insurance claims, maintaining accurate accounts receivable records in the organization’s practice management system and provider/facility credentialing.
 
QUALIFICATIONS:
 
High school graduate or equivalent.
Two years of experience in a medical office environment to include work with Medicaid, Managed care organizations, commercial and other third-party payer claims submission and appeals.
Federally Qualified Health Center (FQHC) experience preferred.
Experience with medical and dental terminology, procedural and diagnostic coding (ICD, CPT, CDT, and HCPCS).
Maintain compliance with HIPAA regulations.
Good oral and written communication skills.
Ability to deal professionally, courteously and efficiently with the public and all levels of the organization.
Ability to handle multiple projects simultaneously.
Ability to operate a computer, copier, fax, and 10-key machine.
Proficient in practice management system and Microsoft Office software applications.
Basic accounting knowledge.
 
ESSENTIAL DUTIES AND RESPONSIBILITIES:
  1. Responsible for appealing and preparing denied or rejected insurance claims for resubmission.
  2. Responsible for monitoring the patient insurance accounts receivable aging reports and using the reports to identify accounts requiring attention.
  3. Responsible for collections of insurance and/or patient balances.
  4. Responsible for identifying outstanding and delinquent insurance claims and pursuing payment for those claims.
  5. Review insurance and patient accounts and request adjustments and/or refunds, as appropriate.
  6. Responsible for identifying patterns of denials from insurance carriers.
  7. Assist with posting payments.
  8. Responsible for staying current with the rules and regulations and updates or changes in state and federal regulations.
  9. Inform billing manager of accounts receivable issues, and the potential effect the issues may have on the organization and reimbursement.
  10. Continually search for ways to improve the accounts receivable process, striving for efficiency in daily operations.
  11. Compiles and maintains current and accurate billing data for all providers in the practice management system.
  12. Completes provider credentialing and re-credentialing applications; monitors applications and follows up as needed.
  13. Obtain and track provider care organizations patient panels.
  14. All Health Center staff members have emergency and disaster response responsibilities. Participates in all safety programs which may include assignment to an emergency response team.
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