Insurance Billing Clerk

POSITION TITLE: 108 - Insurance Billing Clerk LOCATION: Business Office REPORTS TO: Director of Patient Finance REVISION DATE: 4/14/2026 QUALIFICATIONS: - EDUCATION: Minimum high school diploma or equivalent required for all positions (may be allowed to sign a GED agreement to obtain within 6 months). - EXPERIENCE: - PREFERRED: Experience in insurance billing and follow-up. - OTHER REQUIREMENTS OR LICENSURE: Occasional travel from off-site business office to hospital or clinic locations. JOB DESCRIPTION: The job description reflects the general details considered necessary to fulfill the essential job functions and shall not be construed as all-inclusive of all work requirements inherent in this position. Other specific job-related knowledge and skills may be required. All employees subject to an annual performance evaluation based on the duties and responsibilities of this position. PHYSICAL DEMANDS & WORKING ENVIRONMENT: Usual working space is a well-ventilated area. Requires standing, walking, turning, bending, stooping, and lifting. Clear speech to communicate effectively with customers (e.g. patients, families, and other team members). Fine and gross motor skills. Environment may be stressful at times, therefore ability to work under stressful conditions is necessary. Lifting up to 50 lbs may be required, anything over 50 lbs should be a team lift or with the use of a lifting aid. Frequent sitting at desk, looking at computer screen and writing, occasional stair climbing. COMPLIANCE AND REGULATORY EXPECTATIONS: All employees are expected to conduct themselves in a manner that upholds the highest standard of integrity, ethical behavior, and regulatory compliance. As a condition of employment, employees must adhere to: · OCH Code of Conduct · OCH Policies and Procedures · Scope of Practice within License/Certification. · HIPAA and HIPAA Security Confidentiality Standards · Workplace Safety · Mandatory Training · Annual Compliance Education ESSENTIAL JOB FUNCTIONS & KEY RESPONSIBILITIES: • Managing the follow-up and collections of institutional claims for the hospital. • Assist in filing insurance claims, determining write offs, and resolving coding issues. • Meeting monthly collection goals by maintaining aged AR balances greater than 90 days old at under 12% of total assigned insurances. • Following up daily to resolve denied and non-covered claims/services by calling insurance companies, using payer websites, and working with provider representatives to have claims reprocessed • Filing disputes and appeals, when necessary, with supporting documentation. • Utilizing provider portal websites to check eligibility, claim status, authorization information, member COB files, etc. • Reviewing and resolving claims in the denial management worklist • Working with Payer Representatives to problem solve ongoing issues and stay educated on any updates from the payer. • When necessary, billing secondary institutional claims either electronically or by paper claim submission. • Working credit balance worklist • Contacting patients to resolve coverage or billing concerns when necessary. • Participating in educational activities and staff meetings when necessary. • Maintaining confidentiality and adheres to all hospital policies, including HIPPA guidelines. • Other duties as assigned. QUALIFICATIONS: - EDUCATION: Minimum high school diploma or equivalent required for all positions (may be allowed to sign a GED agreement to obtain within 6 months). - EXPERIENCE: - PREFERRED: Experience in insurance billing and follow-up. - OTHER REQUIREMENTS OR LICENSURE: Occasional travel from off-site business office to hospital or clinic locations.