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Revenue Cycle Specialist

4 months ago

Oakland, United States Asian Health Services Full time

Asian Health Services, founded in 1974, provides health, social, and advocacy services for all regardless of income, insurance status, immigration status, language, or culture. Our approach to wellbeing focuses on “whole patient health,” which is why we provide more than primary care services, including mental health, case management, nutrition, and dental care to more than 50,000 patients in English and 15 languages: Korean, Lao, Burmese, Mandarin, Cantonese, Spanish, Portuguese, French, Mien, Karen, Mongolian, Karenni, Tagalog, Khmer, and Vietnamese. We offer medical, dental, and mental health services for all ages.

**LOCATION: ARC**

**JOB SUMMARY**:
Under the direction of the Revenue Cycle Manager (RCM), the Revenue Cycle Specialist is responsible for maintaining the medical billing system including all charges and payments. Ensure all medical services provided by the clinic are properly billed and paid. Participate in analyzing and resolving department-wide problems, such as operational workflow issues, or EHR EPM system-related issues.

**Essential Job Functions**:

- Responsible for timely follow up on denied Federal Qualified Health Center (FQHC), Remittance Advice/Explanation of Benefits (RA/EOB) for Medi-Cal and Medicare claims, for all fee for service billings, and denied RA/EOB for private insurance and HMO commercial claims. Verify through the online FSS system.
- Reviews and analyzes overpayments from Medi-Cal for Medicare Part B and initiate the refund process as necessary.
- Review billing reports ensuring proper billing procedures are followed based on federal and state rules and regulations.
- Communicates issues with the electronic billing and payment posting system to Supervisor, Manager, and or IT/IS department.
- Monitors and tracks patients’ accounts receivable aging reports. Makes necessary adjustments for outstanding balances to resubmit claims, and/or recommend write-off to RCM.
- Keeps updated on new information related to Medi-Cal/Medicare, Managed Care, and other third-party billing.
- Reconciles all managed care capitation and fee-for-service reports for SB 1194
- Communicates information and trains other staff.
- Assists RCM in addressing issues, questions, and problems raised by Revenue Cycle Assistants, and other staff in Patient Services regarding patient bills.
- Works with providers to correct any valid billing procedures and diagnostic codes on denied claims.
- Attends meetings and training related to billing procedures as appropriate.
- Addresses issues, questions, and problems regarding patient billing from patients, third parties involved in billing, and payers. Adjusts patients’ ledger/accounts as needed.
- Reviews capitation report for patient eligibility and fee-for-service reports as appropriate.
- Monitors the impact of changes in third party billing policies and procedures at Asian Health Services (AHS), and communicate these to the RCM and other members of the Billing department.
- Makes recommendations for future upgrades and operational enhancements
- Responsible for Medicare and Behavior Health service billing to Beacon and Blue Cross Managed care.
- Responsible for sending out monthly patient statements.
- Participates in special AHS internal committees and task forces, as requested.

**General Agency/AHS Duties**:

- Fosters an environment that promotes trust and cooperation among clients and staff.
- Enforces clinic policies and procedures, including maintenance of client confidentiality under HIPAA privacy rules, to ensure that the principles of AHS are implemented.
- Plays an active role in planning organization-wide activities such as AHS general membership meetings, fundraisers, special clinic days, and other events.
- Participates in general membership meetings, fundraisers, and other public events, as required.
- Participates in outreach activities, agency advocacy, and serves on ad hoc committees, as requested.
- Attends AHS staff retreats and Board of Directors meetings, as required.
- Participates in agency-wide quality improvement program processes and performance improvement teams to ensure excellence in the quality of services provided across the agency.

**Minimum Qualifications**:

- High school diploma or GED
- Three years’ experience handling progressive administrative responsibility or equivalent combination of education and experience

**Preferred Qualifications**:

- Bilingual/bicultural in an Asian language.
- Commitment to working in the Asian community, to community health care with familiarity with community health clinics.
- CPT procedure and ICD-10 diagnosis coding.

**Knowledge, Skills & Abilities**:

- Ability to work collaboratively with other AHS supervisors and managers with a focus on customer service and quality of care, exemplifying the core values and mission of the organization, always exercising utmost discretion, diplomacy and tact inpatient/staff interactions.
- Basic working knowledge of medical terminolog