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Medical Office Billing Clerk–Rev Cycle/Ins Appeals (U2644-rs)

Medical Records | San Antonio, TX | Full Time and Temporary

Job Description

Medical Office Billing Clerk Intermediate

Revenue Cycle / Insurance Appeals

Temporary Staffing


Purpose of Position:

The purpose of position is to perform medical insurance billing and collections activities for various Medical Departments. The position requires clerical skills to bill and appeal third party insurance claims to Medicare, Medicaid, Commercial Insurance carriers as well as Governmental payors.  Candidate will also be responsible for billing on corporate and research accounts.

Preferred Qualifications:

Working knowledge of insurance rules and regulations as they pertain to Managed Care, Medicare, Medicaid, HMO's, Commercial Insurance Carriers and Governmental Payors. Experience with patient billing software is recommended. Experience with Epic is particularly desired. Working knowledge of Microsoft Office Programs- Excel and Word preferred for spreadsheet billing and collection communication.  Provide support to UTPA Billing/Coding department by providing data entry and report generation though the Epic/Sunrise EMR system.   Prefers 3-4 years’ experience in Medical Billing with strong 10-key experience by touch.  Accuracy in data entry is required.  Knowledge of Medical terminology preferred. The position may be considered for longer assignment based on skill level of employee and work load of department. Work hours Mon-Fri 8-5pm, with 1-hour lunch. ​

Job Duties:

Review claims that have been adjudicated by Medicare, Medicaid, Commercial, various HMOs as well as Governmental non- contracted payors for appropriate billing.  Additional duties may include review of Corporate and Governmental Payor Charge Review Work Queues to ensure appropriate billing of charges.

Address denied claims by phone, mail and payor website for reprocess. Follow-up on claims pended for medical necessity, and claims pending for supporting documentation and/or medical records by working with various teams such as clinic staff, registration staff, and coding staff to complete appeals. Additional duties may include set up of guarantor accounts as well as resolution of patient billing disputes. Additional duties may include set up of guarantor accounts as well as resolution of patient billing disputes as they pertain to funding from corporate or research accounts.

Extract information regarding patient treatment from medical records and work closely with coding staff to compose individualized appeal letters. Identify payor specific patterns or trends regarding denials and report these to Management for communication to Medical Departments and Administrators. Make the necessary recommendations regarding billing and edit creation to reduce denials. Additional duties may include preparation of monthly invoices on accounts, working with payment posting staff to review charges and payments based on agreements, and report discrepancies in billing back to departments.

Remain current in all payor specific guidelines and/or funding agreements.  Be able to utilize various collection processes and be able to submit appeals and resolve discrepancies.


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