JOB SUMMARY
The Insurance Claims Clerk is responsible for processing, submitting, and following up on insurance claims to ensure accurate and timely reimbursement. This role requires strong attention to detail, knowledge of payer regulations, and the ability to resolve claim issues efficiently. The Insurance Claims Clerk serves as a key liaison between insurance companies, patients, and internal departments to support the financial health of the organization.
ESSENTIAL JOB FUNCTIONS
Generate and submit insurance claims to commercial, government, and third-party payers in accordance with established guidelines.
Monitor aging reports and follow up promptly on unpaid, underpaid, or pending claims.
Research and resolve claim denials, discrepancies, and rejections by submitting appeals, corrections, or additional documentation.
Accurately post insurance payments, contractual adjustments, and patient responsibility amounts to accounts.
Verify patient insurance eligibility and benefits prior to claim submission and during patient encounters.
Communicate with insurance companies, patients, and internal departments (billing, coding, clinical staff) to resolve claim and billing issues.
Maintain compliance with HIPAA regulations and payer-specific billing requirements.
Document all actions taken in claim files and billing systems to ensure accurate record-keeping.
Assist with preparing reports related to claim activity, reimbursement trends, and outstanding balances.
Stay current on payer requirements, coding changes, and insurance regulations affecting claims processing.
other duties as assigned.
REQUIRED LICENSE, CERTIFICATION, EDUCATION, SPECIALIZED SKILLS
High School Graduate or equivalent. Certification in Medical Billing (CPB). 1 year experience in medical billing. Familiarity with CPT, ICD-10, HCPCS codes and EOBs. Knowledge of Medicare, Medicaid, and commercial insurance guidelines.
Intergy, Vista, EHR systems, and OHCA portal experience a plus. Basic computer skills.
Must be detail oriented and organized.
10 Key proficient.
WORKING CONDITIONS
OFFICE CLERICAL: Mostly sedentary. Must be able to sit in a chair most of the day to do the work. Must be able to maneuver the body while sitting and using a computer keyboard. Minimal standing, walking, bending, carrying of light items (up to 15 pounds) such as papers, books, files, and lifting of mail baskets and office items.
About Indian Health Care Resource Center
Utilizing a patient-centered, multidisciplinary, medical home approach, Indian Health Care Resource Center, a 501(c)(3) nonprofit organization, offers a full range of health and wellness services tailored to the Indian community.
MISSION
The mission of the Indian Health Care Resource Center of Tulsa, Inc. (IHCRC) is to empower the American Indian through exceptional healthcare!
VISION
At IHCRC, we will be the recognized leader in redefining primary healthcare for the American Indian.
HEALTH PROMOTION AND DISEASE PREVENTION GOAL
The long-term goal of IHCRC is to improve general health status and reduce the incidence and severity of chronic disease by engaging the Indian community in ongoing health promotion, and disease prevention and management programs.
Applicants must create an account with UKG in order to apply for this position.