Medical Billing and Denial Specialist

1 month ago

Garden Grove, United States Titanium Healthcare Full time

**Job Summary**: Titanium Healthcare is seeking a motivated Billing Specialist to join our growing and dynamic team. This individual will be responsible for the posting, evaluation and billing of claims and outstanding account receivable within the EHR (electronic health records) system. This includes evaluating EHR data integrity as it relates to account receivable, performing data entry/reporting and billing tasks. In addition, the billing specialist will be responsible for ensuring that information is processed accurately, payments are posted, and denials are resubmitted in a timely fashion. This individual will work in collaboration with the revenue cycle, finance and data team.

**Essential Functions**:

- Identify, notify and work with internal team members of denial patterns and issues. Be able to collaborate with direct manager and other team members to resolve issues timely.
- Be able to evaluate patient accounts and take charge of insurance and patient outstanding payments. Be able to articulate reasons for patient balance occurring directly with patient.
- Manage, track and resolve complex denied and voided claims. This includes following through until the claim is paid.
- Achieving maximum reimbursement for services provided.
- Preparing and submitting billing data and medical claims to insurance companies, including 837 and 1500 claims.
- Monitoring and recording of payment plans for patient statements.
- Be proactive, creative and flexible in determining, evaluating, researching and resolving issues.
- Organize and prioritize multiple activities to meet all external and internal deadlines.
- Post payments accurately and timely to accounts.
- Collaborate with revenue cycle manager and operational leadership on frequent issues to consult and advise on how to correct errors moving forward. Develop and maintain claim resolution skills through continuous trainings, workshops and education in collaboration with revenue cycle manager.
- Be able to check eligibility on a bi-monthly basis for clients and compiling list of clients with terminated Medi-Cal as needed and provide management and operation’s team reports.
- Be able to prioritize task and create a tracking system of claims and health plans that are worked on.
- Respond to requests and communication timely (typically less than 24-48 hours).
- Assist in the creation and review of billing procedures to ensure the company maintains compliance with local, state and federal regulations.
- Other duties and projects as assigned.

**Qualifications**:

- **Education**:Minimum of high school diploma required. Associate degree in medical field preferred.
- **Experience**: 3+ years of clinical AR, practice management and/or medical administration experience required.
- **Language**:Fluent in English (written and verbal). Bilingual in Spanish preferred.
- **Skills required**:

- Able to understand and become proficient in medical billing software-basic knowledge.
- Familiarity with Medi-cal, Medicare, commercial and patient statement billing.
- Proficient with Microsoft Outlook and associated products.
- Ability to be accurate, precise, thorough and detail oriented.
- Must have initiative, and relies on experience and sound judgement in making decisions in varied situation to accomplish goal.
- Familiar with the utilization of an EHR (electronic health record) system.
- Ability to multi-task, prioritize and see projects through to completion.
- Can work independent and is self-directed. Excellent organizational capabilities and attention to details.
- Experience with primary care and Medi-cal billing preferred.
- Experience with EClinicalWorks preferred.

**Physical Requirements**: Physical demands associated with office work and driving, including but not limited to:

- Consistently operating a computer and other office equipment such as a telephone, calculator, copy machine, and printer.
- Must be able to remain in a stationary position 75% of the time.
- Must be able to move around the office up to 50% of the time.
- Occasional moving or carrying office equipment weighing up to 15 pounds across offices.
- Ability to operate a vehicle and/or travel to meetings and different office locations as required or requested.

**Benefits**:

- This is a hybrid role working from home while still servicing members in person
- Medical, Dental and Vision Insurance
- We cover up to 100% of your premium and 50% of your dependent premium depending on the plan
- Flexible Spending Accounts, Health Savings Accounts & Dependent Care Accounts are also available
- Life, AD&D and Short-Term Disability Insurance funded 100% by Titanium Healthcare
- 401(k) plan
- Employee Assistance Program
- 11 Paid Holidays, 3 weeks of all-inclusive PTO per year (accrual begins on the first day of employment) as well as a separate Paid Sick Time balance

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