Under direct supervision, researches, extracts, codes, and enters patient demographics, charges, and adjustments. Verifies insurance benefits. Performs final billing. Refers claims to insurance area as necessary. Researches and reconciles payments from insurance and self-pay. Verifies account balances. Initiates transfers if necessary.



Essential Functions:

• Prepares source documents for health plan/non-plan self-pay for entry of billing information.

• Reviews visit records, Ancillary Services and Emergency Room visit records; ensures source document includes essential information required for data entry (e.g. MR#, birth date, address, group number, subscriber name, attending physician, date of service); researches missing information.

• Codes CDM number of services provided; adjusts fees according to health plan benefits; applies prevailing rates for non-health plan patients.

• Registers patient and guarantor in system; enters charges; verifies totals against source documents for all billable services, regardless of billing type.

• Enters additional charges to patient accounts form source documents prepared by insurance clerk; performs insurance benefits maintenance; verifies proration of insurance; performs final billing; refers claims to insurance area as necessary.

• Enters adjustments to patient accounts into computer from already prepared source documents.

• Researches payer remittances for posting; determines patient account and proper insurance company/plan; determines contractual adjustments appropriate for insurance company/plan if underpayment or overpayment; transfers unidentified payments to suspense account; refers to supervisor or proper insurance area.

• Posts remittances and contractual adjustments to patient account; performs accounts receivable transfer when necessary to show proper liability; verifies zero insurance balance after remittance posting; refers account to insurance area if necessary; initiates rebilling action if patient still bears liability after all insurance remittances received; verifies batch total of remittances posted or suspended.

• Batches and files source documents for all data entry; assigns batch number for input and computer reports; verifies number and total for data entered.

• Performs miscellaneous data entry as assigned (e.g. updating of patient information, CDM additions, statistical data entry).

• Operates standard office equipment; maintains files and office supplies as necessary.

• Performs other duties and accepts responsibility as assigned.