Claims Processing Clerk, Sr. receives and inputs new healthcare claims, processes payments, conducts billing research, and responds to telephone inquires. Evaluates claims and administers payment, denies, or returns claims according to policy provisions and organizational guidelines. Being a Claims Processing Clerk, Sr. produces routine and ad hoc reports. Requires a high school diploma. Additionally, Claims Processing Clerk, Sr. typically reports to a supervisor. The Claims Processing Clerk, Sr. works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. To be a Claims Processing Clerk, Sr. typically requires 3-5 years of related experience. (Copyright 2024 Salary.com)
Position Summary
The Processing Clerk in the Health Information Management department performs all of the functions of a Chart Clerk in addition to the functions related to medical record assembly and analysis including Physician Incomplete Chart Area.
Core Duties and Responsibilities
• Separates and assembles the medical record in strict chronological order according to the approved list.
• Prepares the charts for electronic processing by inserting document cover pages
• Scans loose reports and ensures that the reports are in the patient’s record accurately and timely.
• Conducts chart analysis utilizing the electronic medical record, according to departmental policy for written, typed and signature deficiencies and then assigns to the appropriate healthcare practitioner for completion.
• Monitors the department phone and handles as needed.
• Assists with the scanning of the electronic record (i.e. scanning, quality checks).
• Verifies receipt of all the previous day’s discharges from the units. Notifies the supervisor of any records not received by 10 am.
• Assists with compiling and disseminating data related to chart completion.
• Participates in department and organization quality audits as directed by supervisor.
• Assists with the scanning of the electronic record (i.e. scanning, quality checks).
Minimum Requirements
• High School Graduate/GED / Equivalent Work Experience
• 1 year experience working in a medical office setting or medical records
• Intermediate computer skills, excellent organizational, communication and interpersonal skills
• Must be able to walk and stand for extended periods with the ability to lift, push and pull
Additional information
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required.
• This job description should not be construed as an exhaustive statement of duties, responsibilities or requirements, but a general description of the job. Nothing contained herein restricts the company’s rights to assign or reassign duties and responsibilities to this job at any time.
• Shore Medical Center is an Equal Opportunity Employer. All applicants will receive consideration for employment without regard to sex, affectional or sexual orientation, gender, gender identity, orientation or expression; marital status, domestic partnership status, civil union status, pregnancy, race, creed, ancestry, color, ethnicity, national origin, age, disability, religion, genetic information, or veteran status or any other basis prohibited by law.
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