TeamHealth

JOB DESCRIPTION OVERVIEW:

Under direct supervision, the Clerical Support Representative is responsible for daily administrative and clerical duties in the Clerical Support department. This position involves various processes. Stamping outgoing mail, GDI-Imaging, Clerical MR/Sorting, Sorting Payer Correspondence, Clerical 2 nd INV Billing, Printed Claims-Clerical EOB’s-(Can’t find-Primary EOB’s), Clerical Return Mail, OP Clerical, ETM-Clerical EOB, Bad Address claims report, Matching of Overprovisions Checks and remits. Processing Risk Medical Records request. Ordering of department supplies and other clerical and administrative duties as assigned. The position works in a cooperative team environment to provide value to customers (internal and external). The Clerical Assistant carries out his/her duties by adhering to the highest standards of ethical and moral conduct and acts in the best interest of TeamHealth.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Clerical Support Representatives processes the following: GDI-Imaging, Clerical MR/Sorting, Clerical MR Sorting, Sorting Payer Correspondence Clerical 2nd INV Billing, Printed Claims Clerical EOB’s- (Can’t find-Primary EOB’s), Clerical Return Mail, OP Clerical, ETM Clerical EOB, Bad Address claims report, Matching of Overprovisions Checks and remits.
• Responsible for requesting medical records and following up on these requests from the facilities.
• Responsible for providing only copies of billing statement(s), claims, subpoenas or affidavits in response to attorney, patient or medical record retrieval company’s requests. Billing Center sends the documents through ChartSwap or the U.S. Postal Service (USPS).
• Retrieves/receives the medical records via mail or electronically and sorts the medical records.
• Receives medical record requests daily through the Advanced Web ETM system
• Distributes the medical records to the appropriate recipient.
• Ensures compliance with state and federal laws and regulations, including HIPAA.
• Maintains thorough and detailed knowledge of insurance and follow up guidelines and regulations of third-party payers. Exhibits an understanding of state and federal billing and follow up regulations as it relates to Medicare, Medicaid, and Managed Care and Commercial Insurance companies.
• Exhibits an understanding of CPT, HCPCS and ICD-10 coding regulations and guidelines.
• Demonstrates knowledge of HCFA 1500 billing forms and filling requirements. Exhibits an understanding of electronic claims editing and submission capabilities including Medicare and NEIC on-line claims processing and query system.
• The scanning of all documents into the system on a daily basis, to include, face sheets, payments, correspondence, reports, and anything else needed for patient documentation.
• To verify that all information is appropriately captured in the system.
• To help with the retrieval of any needed documentation.
• In accordance with current TH guidelines, coordinates the destruction of hard copy files.
• May perform special assignments and other related tasks as assigned.
• Meets employer/customer expectations and requirements, and gains employer/customer trust and respect.
• Functions effectively within a team. Participates, and contributes constructively to produce results in a cooperative effort.
• Demonstrates ongoing enthusiasm and commitment to the work assigned.
• May perform special assignments and other related tasks as assigned.

Job Requirements:

QUALIFICATIONS / EXPERIENCE:

To perform this job successfully, an individual must be able to perform each essential duty

satisfactorily. The requirements listed below are representative of the knowledge, skill

and/or ability required. Reasonable accommodations may be made to enable individuals

with disabilities to perform the essential functions.

Education and Experience:

Normally, the knowledge, skills and abilities necessary for adequate job performance can be

obtained through approximately one or more years of experience performing billing functions

within a multi-facility environment and experience with business process design desirable. In

addition, demonstrated success working in a team environment focused on meeting

organization goals and objectives is necessary. Experience with providing visible participation

and support of major change initiatives preferred. Experience (3-5 years) and excellent

working knowledge of billing regulations and requirements including claims

editing and submission processes.

Mathematical Skills:

Knowledge of basic math and the ability to perform math functions in units of American

currency.

Reasoning Ability:

Ability to apply common sense understanding to carry out instructions furnished in written, oral

or diagram form.

Ability to review documents for accuracy and reasonability.

Ability to determine priorities

Ability to coordinate schedules and information.

Personality Traits/Emotional Demands:

Ability to work well under pressure.

Tact and patience when dealing with individuals at all levels, both within and outside the

company.

Commitment to IPC values

Ability to provide visible participation and support of major change initiatives.

Ability to be flexible in problem solving environment.

Certificates and Licenses:

None required.

Language Skills:

Ability to communicate effectively orally, in person and on the telephone, and in writing, with

individuals at all levels, both within and outside the company.

Other Skills and/or Abilities:

Comprehensive experience of inpatient and outpatient billing requirements of HCFA 1500

billing forms.

Ability to multi-task, set priorities and follow through without direct supervision.

Ability to type efficiently and accurately.

Ability to operate a computer (i.e., Microsoft Office-including Word and Excel) efficiently and

accurately.

Ability to operate various office machines (i.e., fax, copier).

Ability to work well in a team environment focused on meeting organizational goals and

objectives.

PHYSICAL / ENVIRONMENTAL DEMANDS:

• May require the manual dexterity and/or frequent use of the computer, telephone, 10-key,

calculator, office machines (copier, scanner, fax) lifting up to 30 pounds, and/or the ability to

perform repetitive motions to comply with the essential functions.

• Requires the physical and/or mental stamina to meet production and quality standards to

comply with the essential functions.

• May require physical and/or mental stamina to work overtime, additional hours beyond a

regular schedule and/or more than five days per week with mandatory overtime as directed by

Management.

• Requires the ability to conform to standards for attendance.
• Job performed in a well-lighted, modern office setting.
• Prolonged work on a PC/computer and telephone.
• Occasional standing/bending.
• Occasional lifting/carrying.
• Prolonged sitting.

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