SHAWNEE COUNTY, KANSAS
Position Description
Account Clerk III (Health)
Position Control Number: HA1143A FLSA Status: N
POSITION DESCRIPTION
Under general supervision, this position maintains departmental accounting records in the Billing
Office within the Shawnee County Health Department. This position is responsible for the billing
of claims, the receipt of remittance advice and payments on accounts. Performs other duties as
required. This position is supervised by the Medical Accounts Receivable Manager.
WORK PERFORMED
40% Medical Claims Processing. Responsible for the submission of timely and accurate
electronic and paper claims to government programs, and primary, secondary, and
tertiary insurance companies. Creates billing files and reviews each claim within the
billing report for correct insurance, Current Procedural Terminology (CPT) codes,
International Classification of Diseases (ICD)-10 codes and units of services as required
by third party payor. Creates and submits the claim file to the claims clearinghouse for
the preparing and sending of claim files to government programs and insurance
companies. Saves and analyzes electronic data interchange (EDI) claim submission
reports, file received reports and electronically formatted claim files. Regularly analyzes
consumer account information and scanned documentation for accuracy.
20% Accounts Receivable and Claims Management. Responsible for appropriate follow up
on all accounts pending payment, up to resolution, which includes working monthly
accounts receivable reports, performing corrections and resubmitting claims to payor,
coordinating refunds, resubmissions, and adjusting claims. This position must file claim
denial appeals when necessary.
Responsible for identifying periodic claim denials and researching resolutions.
Determines whether denials are an internal/system coding issue or if it is a payor system
issue. This requires analyzing previous claims, Remittance Advices (RAs) and other
claim reports. Identifies possible patient management system issues, accesses payer claim
portals, and contacts customer service. Follow up on denial resolution is required.
Responsible for learning and use of payor websites for referencing claims, staying current
on coverage and reimbursement guidelines, and to obtain needed forms to process claim
reconsiderations and payment recovery. Learns and uses other websites and systems as
necessary. Performs regular billing audits and manages accounts receivable reports.
20% Posting Payments. Processes payments and refunds from government programs,
insurance companies/payor and consumers. Review Remittance Advices (RAs) for
incorrect reimbursement of services. Must be able to read and understand all payor RAs,
regardless of format. Must learn and understand the use of claim adjustment codes,
