Medical Billing Specialist

5 hours ago

Santa Rosa, California, United States Santa Rosa Community Health Full time
Job Summary

A Medical Biller/Collector is responsible for accurate and timely billing insurance plans, collection and posting of payments, all claims follow-up, billing of secondary claims, and posting patient charges as directed by Billing Supervisor.

The Medical Biller/Collector has knowledge of all aspects of billing insurance plans, Medi-Cal, Medicare and special aid programs, and patient collections.

Key Responsibilities
  • Inputs charges for private pay, insurance, Medi-Cal, Medicare and special aid programs into the practice management system.
  • Sees to completion of charges regarding DX & procedures.
  • Process and submits primary claims electronically.
  • Submits patient statements 2-3 times a week.
  • Copies and submits paper claims.
  • Able to answer billing, insurance, and aid program questions and understands account balances.
  • Makes calls to insurance companies regarding proper address of claims and eligibility as needed.
  • Assists in daily collection of patient balances.
  • May handle daily cash, balance to a daily journal.
  • Audits and corrects demographics as needed.
  • Makes calls to and receives calls from patients as needed regarding billing and statement questions.
  • Applies patient payments, insurance payments and copays as instructed.
  • Audits and corrects demographics as needed.
  • Maintains an up-to-date billing manual for reference and/or is familiar with where to locate information on the internet.
  • Call insurance carriers to check status of claims.
  • Accurately uses ICD10, CPT, and HCPCS coding.
  • Keeps Accounts Receivable to 45 days by working Aging and timely follow-up of unpaid claims and working claim denials.
  • Identifies and resolves billing and claim queries/problems.
  • Performs any work as described above in an independent, responsible manner.
  • Participates in ongoing training.
  • Other duties as assigned.
Requirements
  • High school diploma or equivalent.
  • Experience with eCW preferred.
  • Insurance billing experience preferred.
  • Knowledge of medical billing and collections terminology.
  • Must take initiative and work in an independent fashion.
  • Ability to perform diversified clerical functions and basic accounting procedures.
  • Ability to effectively communicate with people at all levels and from various backgrounds.
  • Commitment to excellence and high standards.
  • Strong organizational, problem-solving, and analytical skills.
  • Acute attention to detail.
  • Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm.
  • Knowledge of claim follow-up for Medicare, Medi-Cal, CDP, Family Pact, private insurance, CHDP and more.
  • Ability to make status calls to facilitate claim payment.
  • Ability to make calls to patient to facilitate payment plans on aged accounts.
  • Able to meet aggressive collection goals.
  • Ability to successfully handle claim denials.
  • Demonstrated outstanding customer service.
  • Ability to work independently and as a member of the collections team.
  • Fluency in English and Spanish (speak, read and write) preferred.
  • Ability to work a flexible schedule.
  • Demonstrates knowledge of compliance issues within the community clinic environment.
  • Demonstrates a willingness to report any incident that is unusual or incompatible with accepted clinic procedures.
  • Always maintains confidentiality of patients by complying with HIPAA policies.
  • Strong interpersonal skills; ability to be sensitive with persons of various social, cultural, economic, and educational backgrounds.
  • Proficiency with Microsoft Office applications including Outlook, Word, Excel and PowerPoint.
  • Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines.
  • Strong written and verbal communication skills.
  • Good judgment, problem solving and decision-making skills.

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