General Information:
The Back Office Insurance Clerk does not generally have direct patient contact. They are the ones who input the patient's billing information, post charges to their accounts, create the bills that go out to the insurance companies, post payments and adjustments from the insurance companies and follows-up with the insurance companies when the bills are not paid or paid incorrectly.
The back office personnel must know all the rules of insurance as well as the various types of insurances, their co-pay requirements, what services are covered and which are considered non-covered, what precertifications may be required and if any referrals are needed.
The billing person must know medical coding to ensure that all of the claims are paid at the highest rate allowed by the contract with that particular insurance type or group. These include both CPT and ICD-9 diagnosis codes. Most billing software includes information on these codes however the Billing Clerk must know when the wrong code was entered and be able to find the correct one.
Whether your office is fully automated, still done with paper or some mix of the two you will still need to post the charges, subtract the payments and adjustments and determine what, if anything, is still owed by the patient for every visit. You will need to follow-up with insurance companies on claims not paid, not paid correctly and claims denied. As a courtesy most offices will send in additional information to the insurance companies to get a disputed claim paid.