Account Clerk III (Health)
- Expired: over a month ago. Applications are no longer accepted.
Under general supervision. This position maintains departmental accounting records in the Billing Office. This position is responsible for the billing of claims, the receipt of remittance advices and payments on accounts. Performs other duties as required. This position is supervised by the Office Manager II.
40% Accounts Receivable/Claims Management. Responsible for appropriate follow up on all accounts pending payment, up to adjudication, which includes: working monthly accounts receivable reports, making needed corrections and resubmitting claims, coordinating refunds, resubmissions and adjusting claims. Must file claim denial appeals when necessary.
Responsible for identifying periodic claim denials and researching resolutions. Determine whether or not denials are an internal coding or system issue or whether it is a payer system issue. This requires analyzing previous claims, Remittance Advices (RAs) and other claim reports (rejection reports) identifying possible patient management system issues, accessing payer claim portals and contacting customer service. Follow up on denial resolution is required.
Must learn and use payer websites for referencing claims, staying up to date on coverage and reimbursement guidelines, and to obtain needed forms to process claim reconsiderations and recoupments. Must also learn and use other reference websites such as WPC for denial management. Subscribe to pertinent billing list-serves including payer specific sites and CMS. Perform periodic billing audits and manage accounts receivable reports.
25% Medical Claims Processing. Responsible for the submission of timely and accurate electronic and paper claims to government programs, primary, secondary, and tertiary insurance companies. Create billing files and reviews each claim within the billing report for correct insurance, CPT codes, ICD-10 codes and units of services as required by third party payers. Create and submit the claim file to the claims clearinghouse, which then prepares and sends the claim file to the government programs and insurance companies. Save and analyze electronic data interchange (EDI) claim submission reports, file received reports and electronically formatted claim files. Often requires review of consumer account information and sometimes scanned documentation.
15% Posting Payments. Process and post payments from government programs, insurance companies/payers and consumers. Process and post refunds to government programs, insurance companies/payers and consumers. Review RAs for incorrect reimbursement of services. Identify and research payment errors, claim denials and all claims processing errors. Identify and analyze reoccurring claim denials and/or other claim processing issues and bring them to the attention of the Billing Office Manager II. Must be able to read and understand all payer RAs (all are formatted differently). Must understand the use of claim adjustment codes, Remittance Advice Reason Codes, (RARC) and Claim Adjustment ReasonCodes (CARC).
10% Consumer Statements/Collections. Review consumer accounts monthly for accuracy ofservices being billed and insurance eligibility. Also reviews accounts for non-payment todetermine if they are eligible to be sent to the collection agency. Statements are printed andprepared for mailing.
5% Deposits. Verify individual cash drawer balances to system financial reports daily. Preparedaily deposits and enter deposit information into County accounting system. File andmaintain records for auditors. Responsible for following internal cash control policies.Perform monthly cash drawer audits.
5% Clerical Duties/Customer Service. Provide the highest level of customer service to a widevariety of internal and external consumers. Answer consumer’s billing questions and workwith consumers on payment arrangements. Work with government programs and insurancecompanies/payers and other vendors to resolve claim and billing issues. Must effectivelypresent information and respond to questions from managers, staff, consumers, generalpublic and payers. Perform other duties as assigned.
KNOWLEDGE, ABILITIES AND SKILLS
- General office machines and modern office practices.
- The English language, spelling, grammar and arithmetic computations.
- The operation and minor maintenance of various office equipment.
- Basic accounting principles and techniques.
- Generally Accepted Accounting Principles.
- Medicare, Medicaid, and third party billing policies and procedures.
- Interpret and apply Federal, State and County laws, resolutions, rules and regulations.
- Communicate effectively, both orally and in writing, using the English language.
- Follow oral and written instructions.
- Detect and reconcile discrepancies in financial records.
- Operate a variety of office equipment.
- Learn and understand the application of CPT, ICD-10 and HCPCS standardized coding andANSI RARC/CARC codes.
- The use of basic arithmetic including addition, subtraction, multiplication and division.
- The use of computer software and applications.
- The use of cash handling techniques.
High School Diploma or GED Certificate.
Two (2) years of experience in the balancing of accounts or two (2) years of experience in theAccount Clerk II classification.
Six (6) semester hours of college course work from an accredited college or university or onehundred eighty (180) clock hours from an accredited vocational school in financial accounting,banking or closely related field. One (1) year of experience in the balancing of accounts may besubstituted for the required education.
Required to type twenty-five (25) words per minute.Required to achieve 7,000 keystrokes per hour.
No felony convictions.
Valid Driver’s License and able to operate County-owned vehicle (HR2013-2).
HR-2013-2: Driving record that shows: No misdemeanor or felony convictions for traffic/vehicularoffenses (DUI, vehicular homicide, reckless driving, hit and run, etc.) on the driving record that are lessthan five (5) years old; No more than two (2) at fault or chargeable accidents on their driving record thatare less than five (5) years old; No more than two (2) traffic infractions (speeding, failure to yield right ofway, etc.) that are less than one (1) year old.
Required to pass a background investigation, pre-employment physical and drug screen.
Required to complete National Incident Management System (NIMS) 700 and IncidentCommand System (ICS) 100Hcb and 200Hca within six (6) months of employment.
This Position Description is not designed to list all tasks and responsibilities of this position.Shawnee County reserves the right to revise or change job duties as the need may arise. ThisPosition Description does not constitute a written or implied contract of employment.
Shawnee County Health Department
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