Electronic Claims Processor

Position Summary:   Under the direction of the Supervisor, Billing bills and files all claims on both UBs and 1500 forms.  References DDE for verification of beneficiary’s name for Medicare claims.  Identifies and communicates reoccurring billing errors to Manager and recommends solutions.  Adjusts claims as necessary.  Performs Commercial and Medicare billing and research within timeframe and benchmark expectations by Omni Family Health Management.   Utilizes top customer service skills with all customers:  patients, government agencies, commercial insurances, Hospitals, clinic management, staff and outside vendors.

Job Duties:

The following are essential job accountabilities:

1.       On a daily basis submit electronic and paper claims, monthly patient statements and correct claims. On a daily basis provide feedback to office managers & staff, CBO manager on data and demographic corrections.

2.       Coordinate with office managers and Omni Family Health staff to maintain expected daily submission benchmarks for AR collections, closed claims, clean (first pass rate 90%) and bad debt rates <5%. Update spreadsheet with daily statistics.


3.       Process daily DSG EDI requests and receipts to reconcile to patient accounting system submissions and adheres to regulatory guidelines for timely submission and reprocessing.

4.       Submit and receive 837 files from outside vendors.

5.       Manage payer enrollment and EPM maintenance. Notify clinics of updates and changes specific to contract or billing requirements.

6.       Assist in the development, implementation and improvement of internal controls needed to assure and maintain sound billing practices.


7.       Other related duties as assigned or requested.


Additional Duties

  1. HIPAA compliance – Responsible for enforcing compliance with all HIPAA regulations and requirements. Treats all member information confidential.
  2. Compliance – Ensure compliance with all local, state, and federal regulations.
  3. QA/QI – Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
  4. IT – Required to learn and use the Electronic Health Record and Practice Electronic System and its components as required by the job functions and highlighted in the Policies and Procedures.
  5. All employees will participate in Patient Centered Home Health Model at Omni Family Health.
Qualifications, Education, and Experience


1.       High school diploma or GED


  1. Three years of patient accounts, Medicare and commercial physician billing experience.
  2. Prior experience processing claims in a multi-specialty environment for physicians, Hospitals preferably within an FQHC setting.



  1. Ability to work under pressure.
  2. Ability to demonstrate effective communication skills with providers and management staff.
  3. Ability to develop teaching and auditing tools to provide educational programs for physicians and billing staff.
  4. Proficient with excel and other Microsoft office products.


Responsible to:           Billing Supervisor


Classification:             Full-time, Non-exempt