SUMMARY: Serves as a medical billing clerk for the Uniform Business Office (UBO) programs: Third Party Collections (TPC), Medical Services Account (MSA), and Medical Affirmative Claims (MAC). Initiates and processes claims for first or third-party payers on behalf of beneficiaries treated in MTFs.

PERFORMANCE OUTCOMES:

• Educate beneficiaries and MTF staff about the various billing and collection programs and processes to include the requirement of a DD Form 2569, Third Party Collections – Record of Other Health Insurance, and the required complete of an Injury Log.
• Facilitates procedures and processes for Third Party Collections, Medical Service Account and Medical Affirmative Claims IAW DoD 6010.15-M, Military Treatment Facility (MTF) Uniformed Business Office (UBO) Manual.
• Uses other databases (internal or external to MTF) in compliance with HIPAA guidelines to identify insurance coverage.
• Obtains information if necessary through direct patient interviews or by telephone. Insurance companies shall be called for verification of benefits and coverage amounts and to obtain other requirements to be met for reimbursement.
• Inputs and updates patient insurance information in CHCS, AHLTA, or MHS GENESIS and TPOCS or into other databases required by the MTF. Insurance coverage information is obtained, entered into CHCS, and TPOCS or other Government standard system with insurance information for those beneficiaries with billable coverage.
• Reviews medical records when needed for clarification of medical treatment, history of illness, medical tests, accident information or any other clarification for billing purposes.
• Prepares and mails or transmit claims to third party payers using the UB-92, the HCFA 1500, Health Insurance Claim Form, or other form required. Claims may also be processed electronically when available to the Government.
• Conducts follow-up claim inquiries until payment received and/or case is closed.
• Works with the facility Admissions and Dispositions Office to obtain authorizations and precertifications from third party payers.

UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES:

• The Government has three programs within the Uniform Business Office (UBO) three programs: Third Party Collections (TPC), Medical Services Account (MSA), and Medical Affirmative Claims (MAC).
• Armed Forces Health Longitudinal Technology Application (AHLTA)
• Composite Health Care systems (CHCS) and/or MHS GENESIS - specific to MSA, Other Health Insurance (OHI) input, and Third Party Outpatient Collection System (TPOCS).
• Defense Enrollment Eligibility Reporting System (DEERS)
• Military Filing System - by sponsor social security number, terminal digit order, color-coded and blocked filing system.
• Contents of a military medical record, layout, sections, family member prefix designation, forms used in a MTF, and the medical record tracking procedures.

MANDATORY KNOWLEDGE AND SKILLS:

• A fully qualified typist (computer keyboard) with a minimum of 40 WPM is required.
• Demonstrated proficiency with the English language, correct grammar, spelling, punctuation, capitalization, and format to prepare and edit written correspondence, reports, and transcribed material.
• Proficient in use of standard office equipment, such as computers, typewriters, copiers, fax machines, telephone systems and office automation systems, to perform a substantial range of medical billing support.
• Demonstrate general medical ethics, telephone etiquette, and excellent communication and customer service skills.
• Knowledge of Ambulatory Procedure Groupings (APGs), Diagnosis Related Groupings (DRGs), International Classification of Diseases-Version 9 (ICD), and Current Procedural Terminology-Version 4 (CPT-4) coding.
• Ability to read, interpret medical documentation, and understand medical terminology to correctly bill both outpatient and inpatient services