Under general supervision the Billing Control Clerk ensures the orderly flow and timely processing of electronic/manual third party remittance files. Monitors third party payor behavior to identify activity that adversely affects accounts receivable and works with department leadership to resolve issues. Uses multiple computer and banking systems to confirm payments and remittance information validating all files and forms of correspondence by each month end. Compiles reports for the purpose of balancing as well as for statistical reporting to leadership. Participates in quality assessment and continuous quality improvement activities. Performs all job duties and responsibilities in a courteous and customer-focused manner according to the Medical Center's Courtesy Performance Standards. Works under the direction of the Director of Patient Business Services or designee who reviews and inspects work for conformance to established standards and procedures. Exercises working supervision over employees engaged in payment activities.

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High school diploma and/or GED equivalent.

Two (2) years of work experience as a Biller in a hospital or professional setting wherein duties included UB-04 or CMS-1500 electronic billing functions

-OR-

Two years of experience posting electronic or manual payment files in a hospital or professional setting wherein duties included balancing patient and third party payer payments posted into a computerized accounts receivable system.

Knowledge of electronic and manual billing & payment procedures.

Knowledge of third party payer coding requirements (e.g., HCPC, CPT-4, ICD-10 codes) and HIPAA guidelines.

Demonstrated ability to perform basic arithmetic calculations and computations.

Ability to accurately key 100 strokes per minute.

Ability to identify NUCC Code Lists related to a remittance advice.

Ability to keep and maintain records.

Ability to use 10-key calculator.

Ability to develop electronic spreadsheets.

Ability to work effectively with management reports.

Ability to organize, instruct, and give direction to employees regarding changes in computer functions.

Ability to maintain effective working relationships with patients, Medical Center staff, physicians, third party payers, visitors, and the general public.

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1. Ensures control, balancing, and correction of payment posting processes including manual and automated electronic functions. Prepares, distributes, and maintains records of conceptual electronic billing such as updating and editing accounts in computerized system.


2. Ensures efficient, effective, and increased use of electronic payment from third party payors.


3. Posts payments, credits, and updates into computerized and manual systems daily. Processes insurance and/or self-pay refunds as necessary.


4. Investigates and resolves problems with payment vouchers, postings, and remittance errors. Balances vouchers to ensure accuracy of postings.


5. Assists in processing third party payor applications for EFT/ERA initial & subsequent enrollment. Maintains appropriate records and other related files to ensure currency and system compatibility.


6. Acts as a system administrator for third party payor websites. Collects information and processes member access ensuring HIPAA compliance as well as conformance with medical center standard practice.


7. Compiles monthly payment reports. Develops and maintains electronic spreadsheet daily of posted deposits. Conducts audits as directed by departmental supervisors and managers.


8. Analyzes payment errors. Works closely with departmental managers and billing staff to ensure prompt reconciliation of payments in all areas.


9. Identifies opportunities to increase the use of electronic billing and remittance processing to and from third party payors. Communicates solutions to leadership to ensure efficient and effective resolution of revenue cycle balances.


10. Acts as liaison between Patient Financial Services, Finance, Financial Counseling, Information Services, and other designated business associates.


11. Assists in development of improved remittance processing and development of financial workflows.


12. Assists with monitoring the consistent receipt of payor files (i.e. 835, EFT, flat file), and related systems to ensure timely and effective processing of payments. Works with insurance carriers and/or vendors to validate EOB, EFT, check, files, and 835's.


13. Performs other related duties as required. Utilizes new improvements and/or technology that relate to job assignment.