Medical Biller II
10 days ago
Los Angeles
Job Description MISSION, VISION, AND VALUES Our mission is to provide quality, comprehensive healthcare and supportive services to those in our community. Our vision is "Improving the Health and Well Being of our Community." Our Core Values consist of Integrity, Compassion, and Excellence. Employees must possess a strong commitment to the mission, policies, goals and philosophy of Harbor Community Health Centers. JOB SUMMARY Reporting to the Revenue Cycle Manager (RCM), the Medical Biller II is responsible for the billing and collection of the overall clinic’s primary care, pediatric, behavioral health and dental services. This position works closely with providers, front office, and Quality Improvement Department. ESSENTIAL DUTIES & RESPONSIBILITIES To perform the job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required: Insurance Verification and Claim Scrubbing: • Reviews claim insurance, financial classification and run eligibility on all claims prior to submission, • Understands insurance billing, i.e. Medi-Cal, Newborn Gateway and CPE, PP, Family Pact, Medicare, Commercial insurance, and various dental programs., • Understands the application of the Sliding Fee Discount Program, documents and reviews discrepancies with RCM to develop correction plan for improvement, • Ensure complete filing and follow-up of encounter data submission to health plans, IPAs and other payors, i.e. secondary/crossover billing., • Monitor, track, and communicate with providers to assure progress notes are closed in a timely manner., • Respond professionally to billing inquiries from patients, payers, providers, and staff, • Thoroughly analyze patient accounts to ensure that patient balances are accurate, • Generate and submit patient statements monthly, • Ensure that all denials are corrected, re-billed or adjusted timely., • Ensure compliance with HIPAA and payer-specific guidelines., • Assist with closing the billing month-end closing within 10 business days after the end of the month for the prior month., • Participate in training and professional development opportunities to maintain up-to-date knowledge, • Works closely with Front Office (Patient Experience Specialist) to various projects, • Perform other duties as assigned QUALIFICATIONS These specifications are general guidelines based on the minimum experience normally considered essential to the satisfactory performance of this job. Individual abilities may result in some deviation from these guidelines. To perform effectively in this position, the incumbent must have: Education: High school diploma or GED required, Certified Professional Coder and/or Certified Professional Biller preferred Experience: • Must have at least 2-3 years of direct billing experience (in a FQHC setting strongly preferred), • Understand CPT, CDT, HCPCS and ICD-10 coding protocols, Medi-Cal, Medicare, Managed Care and private insurance as it relates to FQHC billing, • Must be bilingual- fluent in English and Spanish, • Must demonstrate good attendance and punctuality and complete all assignments timely., • Must have proficient computer skills, including Microsoft Office abilities, with intermediate Excel skills., • Must have a high level of accuracy, excellent analytical, problem solving and time management skills, and possess strong organizational skills., • Ability to adapt to changes in clinic setting and insurance payors requirements., • Communicate effectively with providers, other staff, and outside vendors., • Work collaboratively in a team environment, have excellent writing skills and be able to prioritize effectively., • Must maintain confidentiality and handle sensitive information with discretion, • Adheres to all HarborCHC’s policies and procedures., • Conducts self in a manner that represents HarborCHC’s core values at all times., • Must possess a solid commitment to the mission, policies, goals, and philosophy of HarborCHC., • Maintains a positive and respectful attitude with all work-related contacts., • Communicates regularly with his/her immediate supervisor about departmental and HarborCHC concerns., • Consistently reports to work prepared to perform the duties of the position., • Meets productivity standards and performs duties as workload necessitates., • Maintain strict confidentiality of all data and information., • Demonstrates integrity and accountability for duties and responsibilities. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. While performing the duties of this job, the employee is regularly required to sit; use hands to manipulate objects, tools or controls; reach with hands and arms; and talk and hear. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust. HOURS OF OPERATION HarborCHC is open Monday-Thursday 7:00am-7:00pm, Friday 8:00 am-5:00pm, Saturday 8:00am-5:00pm with occasional overtime, or other shifts based on clinic need. This is a Non-exempt position, and any overtime must be approved by the Supervisor in advance. HR PROCEDURAL REQUIREMENTS • Legal authorization to work in the United States., • Clear all post offers, pre-employment background screening, and education verification. HarborCHC does not discriminate in employment opportunities or practices on the basis of race; religion; color; sex/gender (including pregnancy, childbirth, breastfeeding or related medical conditions); sexual orientation; national origin; ancestry; physical or mental disability; medical condition; genetic information/characteristics; marital status/registered domestic partner status; age; sexual orientation; reproductive health decision-making; military or veteran status; use of cannabis off the job and away from the workplace; and any other basis protected by federal, state or local law or ordinance or regulation, or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances. This policy applies whether the individual has or is perceived to have any of the characteristics protected by law or is associated with a person who has or is perceived to have any of the characteristics protected by law. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation, and training. DISCLAIMER The above statements define this position as it currently exists and are intended to describe the general content of and requirements for this job. They are not to be considered as an exhaustive statement of duties, responsibilities, or requirements and does not limit the assignment of additional duties at the discretion of the supervisor. HarborCHC is an at-will employer. In addition, HarborCHC may change your duties, compensation or hours, or transfer, reassign, promote, demote, suspend or otherwise change the terms and conditions of your employment (other than the at-will relationship), with or without cause or prior notice. Mon - Fri 8:00 am to 5:00 pm