Billing and Collections Specialist
5 days ago
Job Summary:
The Billing and Collection Specialist is a critical role within our organization, responsible for managing complex billing and collections processes. This includes third-party insurance claims, patient account reviews, eligibility verification, and reprocessing of outstanding claims. The ideal candidate will have strong attention to detail, excellent communication skills, and the ability to meet deadlines while working collaboratively with internal teams and external payers to resolve billing discrepancies and ensure efficient revenue management.
Key Responsibilities:
- Prepare and submit claims to third-party payers, including Medicare, Medi-Cal, Denti-Cal, and commercial insurances.
- Review claims for accuracy, ensuring compliance with payer-specific requirements and regulations.
- Follow up on unpaid or denied claims, reprocessing them as necessary to secure payment.
- Generate and distribute billing statements to patients and third-party payers.
- Monitor accounts receivable, working diligently to reduce outstanding balances and increase collection rates.
- Process patient payments, ensuring all transactions are accurately recorded and posted on the same day.
- Balance daily batches and maintain accurate financial records.
- Prepare and review encounter reports, addressing any discrepancies in visit documentation and billing codes.
- Evaluate accounts for corrections, including adjustments, write-offs, and charge reversals, in line with established policies.
- Collaborate and communicate with clinic administrators, front-line staff, and vendors to resolve billing issues and discrepancies.
- Maintain open communication with the Billing Project Coordinator and Supervisor regarding claim status, workflow, and other critical billing matters.
- Uphold confidentiality and comply with HIPAA regulations in all billing activities.
- Identify areas for improving billing efficiency and accuracy, contributing to the overall financial health of the organization.
- Stay up-to-date with changes in billing regulations, payer requirements, and coding guidelines to ensure continued compliance.
- Perform additional duties as assigned.
Requirements:
- Billing Degree or Certificate.
- High school diploma or equivalent (GED).
- 2-3 years of billing experience, with expertise in Medicare, Medi-Cal, Denti-Cal, and commercial third-party billing.
- Familiarity with ICD-10 coding guidelines.
- Strong interpersonal and communication skills, with the ability to collaborate effectively with managers, administrators, clinic staff, and vendors.
- Proficiency in Microsoft Word, Excel, and Outlook.
- Strong problem-solving skills and the ability to handle difficult situations professionally.
- Ability to manage multiple tasks and prioritize effectively to meet deadlines.
- Excellent interpersonal skills, with the ability to work independently and as part of a team.
- Commitment to maintaining confidentiality and ethical standards in line with HIPAA and other relevant regulations.
Preferred Qualifications:
- Bilingual in English and Spanish.
- Experience working in a Federally Qualified Health Center (FQHC) setting.
Benefits:
JWCH Institute, Inc., offers competitive salaries for all positions. Employees working 30 hours per week or more are provided a monthly allowance which can be used towards medical, dental, and vision premiums. The agency offers sick leave, vacation time, 13 paid holidays, 401(k) Safe Harbor Profit Sharing plan, mileage reimbursement, short term and long term disability plans, life insurance policies, employee parking and more.
Wesley Health Centers JWCH Institute is an Equal Opportunity Employer
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