Job Description: Billing Clerk in Maternal Health Care & Child Health Care Hospitals

A billing clerk in maternal health care and child health care hospitals is responsible for managing the billing and financial aspects of patient care services. They ensure accurate and timely billing, coding, and collection of payments for services rendered to patients. The billing clerk plays a crucial role in maintaining the financial stability of the hospital and ensuring that patients receive the necessary care without any financial burden.

Responsibilities and Duties:

1. Billing and Coding: Accurately code and bill patient services using appropriate medical codes (ICD-10, CPT, etc.) and billing software. Ensure compliance with insurance regulations and guidelines.

2. Insurance Verification: Verify insurance coverage and eligibility for patients. Obtain necessary authorizations and pre-certifications for procedures and treatments.

3. Claims Submission: Prepare and submit insurance claims electronically or by mail. Monitor claim status and follow up on any denials or rejections. Resolve billing discrepancies and resubmit claims if necessary.

4. Payment Processing: Receive and process payments from patients and insurance companies. Post payments accurately to patient accounts. Reconcile payments with billing records and resolve any discrepancies.

5. Patient Billing: Generate and send patient statements for outstanding balances. Answer patient inquiries regarding billing and payment options. Set up payment plans and assist patients with financial assistance programs if needed.

6. Financial Reporting: Prepare and maintain financial reports related to billing and collections. Provide regular updates to management regarding billing and collection activities, outstanding balances, and revenue projections.

7. Compliance: Ensure compliance with healthcare regulations, privacy laws (HIPAA), and billing guidelines. Stay updated with changes in insurance policies, coding requirements, and reimbursement rates.

8. Customer Service: Provide excellent customer service to patients, insurance companies, and other stakeholders. Address billing inquiries and resolve any issues or disputes in a professional and timely manner.

Qualifications and Experience:

• High school diploma or equivalent. Additional education in medical billing and coding is preferred.
• Proven experience as a billing clerk in a healthcare setting, preferably in maternal health care or child health care hospitals.
• Proficient in medical coding and billing software (e.g., Epic, Medisoft, Kareo).
• Knowledge of medical terminology, insurance procedures, and billing regulations.
• Strong attention to detail and accuracy in data entry and financial calculations.
• Excellent communication and interpersonal skills.
• Ability to work independently and handle confidential information with discretion.
• Familiarity with Medicaid, Medicare, and private insurance billing processes.
• Basic knowledge of accounting principles and financial reporting.
• Ability to multitask and prioritize workload in a fast-paced environment.

Note: This job description is a general overview and may be subject to change based on the specific requirements of the hospital and the needs of the department.