Overview

Submits claims to insurance carriers for processing, posts insurance and patient payments accordingly. Calls insurance carriers when claims have not paid within 45 days and prepares to make corrections as needed. Mails patient statements for self-pay balances and corresponds as needed with patients to answer questions regarding billing questions.

The Business Office Collections & Insurance Clerk works closely with physicians and patients and must exhibit effective communication skills, as well as caring professionalism, when dealing with patients and their families. The clerk must also communicate and work well with other physicians, departmental personnel and health care professionals.

Job Specific:

Greet patients professionally upon arrival. (EF)
Answers and direct all incoming phone calls to the appropriate area professionally and politely, by identifying our organization CMP and self. (EF)
Phone calls should be answered by the 3rd ring. 
Ability to Verify Insurance Benefits. (EF)
Understand patient portion, copay, coinsurance, deductibles etc.
Understand different types of insurance plans and products.
Review providers schedules and working accounts for past due amounts and bad debt.
Retrieve test, procedures hospital documentation to send to coders as needed.
File all claims electronically through clearing house following policies and protocols. (EF)
Verify claims transmission are successful. 
Correct errors as presented on rejection report.
Print report from EMD for listing of claims transmitted.
Report any errors and frequency to CMP BO Manager.
Pull Provider Unsigned Notes report.
Process insurance and patient payments accordingly to patient invoices. (EF)
Make proper adjustments as per insurance carrier’s direction.
Knowledge of insurance contractual
Knowledge of insurance fee schedules
Compare payments and fee schedules
Knowledge of Bundled services
Calling insurance companies regarding erroneous adjustments
Move patient portion to patient responsibility accordingly.
Transfer any credits as needed.
Submit refunds following accounting protocols.
Insurance Follow up – A/R follow up
Identify claims that have received no insurance monies or denials.
Call insurance carrier to confirm receipt of claim.
Identify missing or incorrect data, correcting by telephone appeal those items required for correct claim processing.
Filing claims to secondary insurance as needed, either via electronic format or paper HCFA attaching primary EOB.
Identify claims that are patient responsibility and set up patient statements.
Send patient statements monthly. (EF)
Reviewing for possible credits, incomplete addresses, duplicates
Process Final notifications.
Receiving patient calls for questions on billing issues (EF)
Ability to research and resolve questions on:
Payments
Procedures
Adjustments
Insurance processing or lack of
Perform reconciliation process to capture all charges.

Hospital:

Adheres to organization-wide and other applicable policies and procedures.
Day-to-day performance complies with the hospital’s Service Excellence Behavioral Expectations.
Performs within the prescribed limits of the hospital’s Ethics, Compliance and Confidentiality Program guidelines.
Performs within his/her professional Scope of Practice at all times.

Other Duties As Assigned:

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
Minimum Requirements 

MINIMUM REQUIREMENTS

High School diploma or GED
Knowledge of insurance

PREFERRED

Billing and collection experience and at least one year experience in a physician’s office or a clinic setting

COMPANY PROFILE

Citizens Medical Center is a not-for-profit, community hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 317-bed acute care hospital with over 1,200 employees. Voted “Best of the Best” hospital in Victoria for 11 consecutive years, Citizens Medical Center is a level III Trauma Center, currently renovating its 24/7 Emergency Department that includes an onsite medical helicopter. Citizens has a comprehensive Community Cancer Program that includes two linear accelerators and HDR brachytherapy. Citizens is recognized for its outstanding cardiology program which includes a nationally accredited Chest Pain Center and is a Primary Stroke Center. Citizens also includes a comprehensive, accredited Bariatric Surgery program, Birth Center with labor and delivery, an imaging and surgery center, sleep study center, state-of-the-art rehabilitation and fitness center, urology center and daVinci robotics minimally invasive surgery options, a home health agency, and has a long history of providing continuing education for healthcare providers and the community. 

 

 

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Citizens Medical Center is guided by its Mission – “to provide quality medical services at a reasonable cost to the citizens of the region.”

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