Job Information
Waverly Health Center Clinic Billing and Credentialing Representative 1.0 FTE in Waverly, Iowa
SCHEDULE
FTE: 1.0 (40 hours per week)
PRIMARY FUNCTIONS
Conducts a variety of activities within the Clinic Business Office, including, but not limited to, coordination of insurance billing and credentialing for both the clinics and hospital.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Responsible for all insurance credentialing and re-credentialing for Waverly Health Center hospital and clinics.
Sends out regular status updates on provider credentialing to administration.
Assists with hospital credentialing and privileging by coordinating and completing assigned documentation.
Assists in handling and responding to provider needs using current policies.
Keys payments and adjustments to patient accounts. Scans all incoming checks (from insurance) and posts to appropriate accounts, applying discounts when necessary. Pulls in electronic remittance advices from the clearinghouse on a daily basis for electronic posting. Balances posting and makes a daily deposit.
Responds to patients questions regarding their accounts. Answers all insurance questions from front office clerical staff. Work closely with other departments (receptionist and coding staff) in addressing issues related to any service provided.
Reviews Explanations of Benefits that accompany payments. Files balances due to secondary payers or works denied claims from insurance Explanation of Benefits. Files corrected claims based on payer rules. Analyzes accounts that have payer specific edits, timely filing limits or needs filed manually (paper claim). Utilize online insurance systems to check claim status or denials along with being responsible for refunds to patient and insurance companies.
Sends statements on a daily basis, obtains and updates patients address information from returned statements and follows through the collection process on past due accounts.
Sets up Payment Agreements for Private Pay Accounts. Posts payroll deductions for employees. Work with patients to set them up for Care Payment.
Enters all new insurances into electronic medical record, along with correct financial institutions for reimbursement.
MINIMUM QUALIFICATIONS
Education, Experience, and Training
Must possess high school diploma or equivalent.
Two years of medical insurance experience in a physician’s office or clinic setting is preferred.
Strong understanding of Medicare, Medicaid, and commercial insurance rules and regulations as they apply to a physician’s office and/or clinic setting.
Ability to learn and navigate computer systems including the online training modules, the employee timesheet and the performance appraisal system. Job specific systems are also required.
Must have good interpersonal and organizational skills.
Must be able to read, speak, and write fluent English.
Physical Requirements
Sitting – Approximately 100% of shift.
Standing – Not a requirement.
Walking – Not a requirement.
Lifting – Not a requirement.
Twisting – Not a requirement.
Bending – Infrequent.
Squat/Kneel – Not a requirement.
WORK ENVIRONMENT
May come in contact with hazardous chemicals or treatment modalities.
The possibility exists of exposure to communicable disease due to working in a healthcare environment.
Involvement in patient care may result in unavoidable work-related illnesses.