SENIOR CLERK

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This is highly responsible and independent position assisting the billing office and under the direct supervision of the Revenue Administrator I – SES with tasks and/or assignments for the Billing Department of the Office of Public Health Financial Management Division. This position maintains a variety of accounting and financial records for clients’ accounts, which include billing processes for third party reimbursement Ensures all claims are submitted in accordance with each vendor’s established policy and procedures.

Have full knowledge of all medical benefit levels, fee schedule and cost-based reimbursement methodology and regulatory requirements for medical reimbursement. Maintains and respects the confidentiality of patient information in accordance with the County Health Department guidelines, the Miami-Dade County Health department policies & procedures, and HIPAA guidelines.

The incumbent is responsible for gathering all information regarding Medicaid HMO denials and follow-up on appeals process. Communicate payment or denial patterns to management that impact revenues in a timely manner. Works monthly reports to reconcile the payment report against the denial report to identify “No claims on file. Keeps statistical reports of claims monitoring and analyzing the tracking of the age receivable reports by classifying them by age ranges and pay source.

Advises supervisor of all regulation changes reported by vendors that are learned while working denials to ensure compliance and prompt payment. Report to supervisor any coding changes affecting payment of claims. Assist in posting checks to the HMS systems when necessary.

To perform this work, various reports from the Health Management System (HMS) Report Portal must be run monthly as follows: the pending report, the denial report and the charges and payments by payment source reports. In addition, Remittance Advice reports must be downloaded from different websites. FMMIS must be used to audit, research, monitor, and follow-up on Medicaid and HMO Medicaid denied and resubmitted claims.

Works with clinical staff as necessary to re-process denials in compliance with timely billing requirements. Posts remittance vouchers to make sure recoupments of funds are recorded accurately. Verifies Medicaid Member eligibility to assure that the correct Insurance information has been added into the client account Insurance screen in HMS. Make corrections and re-bills. Accumulates errors by front line clerk and sends them for corrections daily.

Reviews the client's information to ensure that tests performed have been properly coded in the HMS System and in accordance with Program guidelines. Verifies accuracy of billed data and corrects any errors coded in HMS.

Assist the Revenue administrator in the daily functions. Prepares meeting agendas presentations, takes meeting minutes and performs other duties assigned due to changes in the Billing office operations.

Verities Medicaid, Medicare and private insurance coverage to submit claims to the corresponding entity. Using FMMIS or other Medicaid or Medicare verification system to identify eligible clients. Reviews claim data submitted on encounter forms for completeness and compliance with guidelines. Prepare encounter forms for all health units to request third party reimbursement for services rendered to patients. Post payments within 48 hours of receipt date.

Re-processes denials within one week of receipt date. This involves working on sensitive confidential information pertaining to clients. Must use the HMS system to process all third parties…