Medical Insurance Clerk

Title Code: 4405 

Occ. Group: 112.961

Medical Insurance Clerk

Expectations for All Employees

East Tennessee State University pursues its mission based upon core values. An employee's job performance must support and exhibit the university's core values:

PEOPLE come first, are treated with dignity and respect, and are encouraged to achieve their full potential;
RELATIONSHIPS are built on honesty, integrity and trust;
DIVERSITY of people and thought is respected;
EXCELLENCE is achieved through teamwork, leadership, creativity, and a strong work ethic;
EFFICIENCY is achieved through wise use of human and financial resources; and COMMITMENT to intellectual achievement is embraced.

Definition 

Employees in this class are under general supervision. Work performed in operating computer terminal, completing insurance claim forms, posting insurance payments received and checking on unpaid claims. Responsible for the total insurance collection process and performing related work as required. 

Characteristic Duties and Responsibilities

Types commercial insurance forms, Medicaid and Medicare forms, completing necessary information concerning the insurance company, policy holder and physician's diagnoses.

Telephones or writes insurance companies regarding status of claims, verification of patient's coverage, or other information.

Posts insurance payments and contacts insurance company regarding unpaid claims.

Answers questions regarding insurance claims, coverage and payments.

Prepares batches of charges, payments, adjustments, and error corrections for daily entry into computer.

Operates computer terminal.

Files, codes, and sorts computer entry data.

Performs other work as assigned. 

Required Knowledge and Abilities

Knowledge of basic medical insurance claim forms and procedures.

Knowledge of simple posting methods and computer terminal operations.

Ability to understand and complete insurance claim forms.

Ability to post claims and payments.

Ability to understand basic medical insurance policies.

Ability to answer questions regarding claims, coverage and payments.

Ability to establish and maintain an effective working relationship with the public and other employees.

Ability to work independently on a variety of responsible clerical tasks.

Knowledge of modern office practices, procedures, and equipment. 

Recommended Qualifications

Applicants possessing these qualifications have a good probability for success in this class. However, applicants not possessing these qualifications should apply if they believe their training and experience will enable them to perform the work successfully. Experience in operation of computer terminal is desirable. Some experience in the medical field, preferably in insurance claims. Graduation from a standard high school or possessing a General Education Development Test Certificate. 

Date         Skill         Eval            
4/18/85        4     413021222

The intent of this job description is to provide a representative summary of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the specific duties and responsibilities of any particular position.