Claims Clerk jobs in Grand Rapids, MI

Job Description

Under the direction of the Provider Compliance and Claims Supervisor, gathers and applies information needed to process mental health service claims and resolve billing issues. Reviews source documents for accuracy and completeness and ensures that all claims are billed and posted accurately.

This is a full-time benefited position based out of the Community Mental Health building in Holland, Michigan. Travel to other County locations as needed. Typical working hours are Monday-Friday 8:00am-5:00pm.

Essential Job Functions

The essential functions of this position include, but are not limited to, any and/or all of the following:

• Verifies patient insurance eligibility.
• Prepares, reviews, and transmits claims using billing software, including EDI and paper claim processing.
• Processes contract agency claims with efficiency and accuracy according to approved rates.
• Reviews insurance aging as assigned, including claims follow-up and re-submission.
• Receives and credits payments to appropriate patient accounts and to appropriate funds and cost centers.
• Audits and verifies requests for disbursement of County funds, including vendor invoices, recurring bills, employee reimbursement requests, and transfers of funds to the state, ensuring that expenses are allowable, properly authorized, and charged to proper accounts.
• Prepares and transmits a variety of bills and invoices for services rendered by contract agencies.
• Prepares and reconciles daily deposit of payments received by mail, in person, on the WEB, and through EFT and ACH transactions.
• Prepares deposits for the Treasurer's Office.
• Responds to questions from patients billed for services rendered by Community Mental Health, explaining services provided and the county's billing policies.
• Sets up ability to pay plans for individuals owing outstanding balances to Community Mental Health.
• Helps support an equitable, safe, diverse and inclusive workplace.
• Performs other functions as assigned.

Required Education, Training and Experience

High school diploma or GED combined with post-secondary training in billing and coding, business information systems, data processing or closely related field and three (3) years of progressively responsible experience in the appropriate area of bookkeeping, general office functions, or insurance billing. This position requires a strong knowledge of billing compliance, CPT Coding, ICD-10 and use of modifiers in addition to an acute attention to detail.

Additional Requirements and Information

Required Knowledge and Skills:

• Good working knowledge of standard accounting principles and practices.
• Proficient working knowledge of Medicaid, Medicare, health insurance regulations, insurance billing, primary payor rules, and general ledger processes and practices.
• Good working knowledge of County policies and procedures.
• Computer literacy, including thorough working knowledge of spreadsheet, database, and electronic health record software.
• Profound organizational skills and ability to prioritize the workload.
• Outstanding customer service skills.
• Exemplary verbal and written communications skills.
• Exceptional interpersonal and human relations skills.
• Ability to interact positively and objectively with managers, supervisors, employees, vendors, contractors, consultants, and members of the general public from a wide range of cultural and socio-economic backgrounds and with varying levels of communications skills.

Job Description

Under the direction of the Provider Compliance and Claims Supervisor, gathers and applies information needed to process mental health service claims and resolve billing issues. Reviews source documents for accuracy and completeness and ensures that all claims are billed and posted accurately.

This is a full-time benefited position based out of the Community Mental Health building in Holland, Michigan. Travel to other County locations as needed. Typical working hours are Monday-Friday 8:00am-5:00pm.

Essential Job Functions

The essential functions of this position include, but are not limited to, any and/or all of the following:

• Verifies patient insurance eligibility.
• Prepares, reviews, and transmits claims using billing software, including EDI and paper claim processing.
• Processes contract agency claims with efficiency and accuracy according to approved rates.
• Reviews insurance aging as assigned, including claims follow-up and re-submission.
• Receives and credits payments to appropriate patient accounts and to appropriate funds and cost centers.
• Audits and verifies requests for disbursement of County funds, including vendor invoices, recurring bills, employee reimbursement requests, and transfers of funds to the state, ensuring that expenses are allowable, properly authorized, and charged to proper accounts.
• Prepares and transmits a variety of bills and invoices for services rendered by contract agencies.
• Prepares and reconciles daily deposit of payments received by mail, in person, on the WEB, and through EFT and ACH transactions.
• Prepares deposits for the Treasurer's Office.
• Responds to questions from patients billed for services rendered by Community Mental Health, explaining services provided and the county's billing policies.
• Sets up ability to pay plans for individuals owing outstanding balances to Community Mental Health.
• Helps support an equitable, safe, diverse and inclusive workplace.
• Performs other functions as assigned.

Required Education, Training and Experience

High school diploma or GED combined with post-secondary training in billing and coding, business information systems, data processing or closely related field and three (3) years of progressively responsible experience in the appropriate area of bookkeeping, general office functions, or insurance billing. This position requires a strong knowledge of billing compliance, CPT Coding, ICD-10 and use of modifiers in addition to an acute attention to detail.

Additional Requirements and Information

Required Knowledge and Skills:

• Good working knowledge of standard accounting principles and practices.
• Proficient working knowledge of Medicaid, Medicare, health insurance regulations, insurance billing, primary payor rules, and general ledger processes and practices.
• Good working knowledge of County policies and procedures.
• Computer literacy, including thorough working knowledge of spreadsheet, database, and electronic health record software.
• Profound organizational skills and ability to prioritize the workload.
• Outstanding customer service skills.
• Exemplary verbal and written communications skills.
• Exceptional interpersonal and human relations skills.
• Ability to interact positively and objectively with managers, supervisors, employees, vendors, contractors, consultants, and members of the general public from a wide range of cultural and socio-economic backgrounds and with varying levels of communications skills.

This position is benefited and is subject to the Group T manual.

Ottawa County offers a wide range of benefits to support you in your career. View the Benefits Summary for more information.

The current Group T manual can be viewed here. The Ottawa County Universal Wage Scale can be found here.