Claims Processing Clerk

Profile

POSITION TITLE:

Claims Processing Clerk

PRIMARY PURPOSE:

This position has primary responsibility for the timely and accurate preparation of billings for services provided by Starfish Behavioral Health Services. In addition, this position will also research rejected claims, to ensure the timely collection of all amounts billed.

Who We Are

Founded in 1963, Starfish Family Services is a nonprofit human service agency, recognized as a champion for children and families across metro Detroit who have limited access to essential resources such as education, healthcare, and economic opportunities. Serving over 4,000 children and their families annually, we provide high-quality programs and support services that focus on early childhood education and development, behavioral health wellness, and empowered parents. Through our holistic approach, Starfish partners with families so they have access to the right resources at the right time.

Qualifications/Job Description

EDUCATION, EXPERIENCE and SKILLS REQUIRED:

1. High school diploma or equivalent required.
2. Demonstrated understanding of or previous experience in insurance medical and/or mental health billing (electronic and paper CMS-1500 claim forms) preferred.
3. Must be proficient in the use of computer software applications and internet.
4. Attention to detail, ability to meet timelines, numerical aptitude and analytical ability.
5. Ability to successfully work with highly confidential information, i.e., knowledge of HIPPAA regulations and PHI.
6. Demonstrated ability in preparing and maintaining accounting records and reports

PRINCIPLE DUTIES AND RESPONSIBILITIES:

1. Batches all claims, and bills based on the established policy via paper claims and/or electronic billing for third party payers, Detroit Wayne Integrated Health Network (DWIHN) and other payers.
2. Processes incoming mail which includes checks, money orders, and credit card payments daily.
3. Deposit all incoming checks and cred card payments.
4. Respond timely to reimbursement rejections or inquiries from various insurance payers.
5. Follow-up on claims that are outstanding beyond the payers specified reimbursement periods.
6. Review flagged emails, Outlook reminders for claim follow ups and Coordination of Benefit updates, etc.
7. Acquire and maintain a working knowledge of 3^rd party billing procedures with Medicare, Medicaid, Managed Care Provider Networks (MCPN) and commercial insurance companies, which includes attending various trainings.
8. Notifies appropriate staff of any changes in reimbursement or billing methods/rates in a timely manner.