Trabajos medical biller en Portland, OregonCrear alertas

Job Description The insurance biller is responsible for preparing, submitting, and resolving insurance claims for both physician and ASC facility services. This role uses Epic billing workflows to ensure timely and accurate claim submission, correct claim edits, manage rejections, and follow up on outstanding accounts. The biller plays a key role in reducing A/R days, improving clean claim rates, and maximizing reimbursement in compliance with payer rules and organizational policies. This position is on-site and requires regular attendance at our Stonemill location. Remote work is not available for this role. Responsibilities: • Support an environment that reinforces Rebound’s mission and Core Values of Superior Service, Teamwork, Integrity, Innovation, Quality and Recognition., • Submit professional and facility claims electronically through Epics module and clearinghouse interface., • Validate claim data using Charge Review and Claim Edit work queues, correction errors prior to submission., • Confirm insurance coverage, place of service, provider information, and coding accuracy prior to release., • Resubmit corrected claims when needed and follow up on rejected or pended submissions., • Work assigned Charge Review, Claim Edit, and Follow up work queues daily to ensure clean claims and timely payer responses., • Route claims to coding or registration or contracting teams when discrepancies impact billing., • Identify trends or repeat edit issues and escalate to management or system support for root cause resolution., • Review payer rejections and denials in Epic and take appropriate action to correct and resubmit claims., • Coordinate with insurance companies via web portals or phone calls to resolve claims issues., • Document all actions taken in account notes to ensure audit trail and communication across teams, • Follow all CMS and commercial payer billing guidelines, including NCCI edits, modifiers, and place of service requirements., • Stay updated on payer-specific requirements for both professional and facility claims, • Maintain knowledge of billing for multiple service lines, including E&M, surgical procedures and ancillary services., • Maintain a high degree of confidentiality and abide by all HIPAA rules and regulations., • Perform other duties as assigned.Qualifications:, • High school graduate or equivalent required., • College level accounting or business courses preferred., • Minimum of two years experience in medical billing in a healthcare related field, physician’s office, hospital or clinic., • Experience in the field of collections, customer service, and insurance billing and reimbursement preferred. Working knowledge of CPT/ICD10 coding, HCPCS, modifiers and payer billing guidelines., • Experience with Medicare, Medicaid and commercial payers. ASC billing knowledge preferred., • Additional appropriate education may be substituted for applicable experience or an equivalent combination of education, training and/or experience., • Knowledge of insurance billing procedures, collection laws, and medical terminology preferred., • Excellent communication and public relations skills, both verbal and written., • Ability to work both independently and interdependently with staff and team members with limited supervision., • Excellent problem solving and critical thinking skills., • Proficient use of computers including MS Office applications., • Must demonstrate an understanding of the principles of service excellence and be able to maintain a professional demeanor and customer service orientation under busy and difficult situations. Physical Requirements and Working Conditions: • Work may require sitting for long periods of time, • Stooping, bending and stretching for files and supplies., • Occasionally lifting files or paper weighing up to 30 pounds., • Requires manual dexterity sufficient to operate a keyboard, type at 35 wpm, operate a calculator, telephone, copier and other office equipment as necessary., • It is necessary to view and type on computer screens for long periods., • Works in close proximity to business office personnel within limited work space. Interaction with others and phones is often disruptive., • Tasks are of minimal hazardous conditions. We are Proud to Offer: • Medical/Vision/Rx, • Dental, • 401(K) Retirement Plan, including discretionary profit sharing and Cash Balance Plan, • Company paid Life Insurance/AD&D, • Voluntary Life insurance/AD&D, • Company paid short and long-term disability, • Flexible Spending and Health Saving Accounts, • Employee Assistance Program, • Free Parking, • Paid Time Off accrued at up to 24 days in your first year based on FTE This is a great opportunity to work in a quality organization with Top Doctors in the Northwest. At Rebound, our goal is to cultivate an organization that offers superior patient-centered medical care, with mutual respect and cooperation in a positive and supportive environment. Come join our team! This position works on-site Monday-Fridays, no weekends or holidays. This is a full-time, 40 hour per week position.

Description Company: Pacific Health Group Department: Revenue Cycle / Billing FLSA Status: Non-Exempt, Full-Time Pay Range: $24 – $26 per hour Position Summary The Clubhouse Billing Analyst owns the end-to-end revenue cycle for Clubhouse Services claims submitted under San Diego County's BH-CONNECT Clubhouse Services benefit. Unlike traditional fee-for-service behavioral health billing, Clubhouse Services is reimbursed through a county-specific daily bundled (per diem) rate claimed through the county SMHS delivery system. This role is responsible for translating daily member attendance and service documentation into clean, compliant claims; managing eligibility, denials, and reconciliation; and serving as the billing subject matter expert on DHCS BH-CONNECT claiming guidance (including BHIN 25009, the BH-CONNECT EBP Policy Guide, and County of San Diego Behavioral Health Services billing requirements). This is a hands-on role for a billing professional who is comfortable operating in a new benefit with evolving guidance — building billing workflows from the ground up, monitoring DHCS and County claiming updates, and partnering closely with program staff to make sure documentation supports every claimed day of service. Essential Duties and Responsibilities Claims Production & Submission • Prepare, scrub, and submit daily bundled rate claims for Clubhouse Services through the County of San Diego's designated claiming system/EHR and ShortDoyle/MediCal process, in accordance with County and DHCS requirements., • Apply correct procedure codes, modifiers, place-of-service, and rendering/billing provider data per BHIN 25009, the BH-CONNECT EBP Policy Guide, and County billing manuals., • Reconcile daily Clubhouse attendance logs and service documentation against claimable member days before submission; flag undocumented or unsupported days to program leadership prior to claiming., • Track and comply with timely filing requirements and County claim submission calendars. Eligibility & Authorization • Verify MediCal eligibility and aid codes for all Clubhouse members monthly (and prior to claiming), including share-of-cost, other health coverage (OHC), and managed care assignment issues that affect SMHS claiming., • Coordinate resolution of eligibility discrepancies with program staff and County BHS as needed. Denials, Corrections & Reconciliation • Work claim denials, disallowances, and voids/replacements; perform rootcause analysis and correct/resubmit within required timeframes., • Reconcile remittances (835s/EOBs) against submitted claims; maintain accurate accounts receivable aging and escalate underpayments or unpaid claims., • Prepare monthly revenue reconciliation reports (claimed vs. paid vs. expected at the County bundled rate) for leadership. Compliance & Audit Readiness • Maintain working knowledge of BHCONNECT Clubhouse Services requirements, including the daily bundled rate structure, medical necessity/eligibility criteria, and documentation standards; monitor DHCS BHINs and County BHS updates for claiming changes., • Understand the Clubhouse International Accreditation requirement and its impact on claiming eligibility (MediCal claiming is limited to four years total prior to Accreditation); support leadership in tracking accreditation-linked billing status., • Support internal charter-claim audits and respond to County/DHCS audit requests, recoupments, and cost report or data submissions as assigned., • Ensure all billing activity complies with HIPAA, 42 CFR Part 2 (where applicable), and MediCal program integrity requirements; report suspected compliance issues immediately. Cross-Functional Support • Serve as the billing liaison to County of San Diego BHS billing/fiscal contacts for Clubhouse Services claiming questions., • Train Clubhouse program staff on documentation elements required to support the daily bundled rate., • Assist with billing workflow buildout, desk procedures, and QA processes for this new service line; support billing for other PHG lines of business as capacity allows. Minimum Qualifications • 3+ years of medical billing experience, with at least 1 year in behavioral health, MediCal, or county Specialty Mental Health Services (SMHS) billing., • Working knowledge of MediCal eligibility verification, aid codes, and claim adjudication (837/835 transactions, denial codes, void/replace processes)., • Experience with an EHR/practice management system used for behavioral health claims (e.g., SmartCare, Cerner/CCBH, Netsmart, or comparable)., • Strong Excel skills (pivot tables, VLOOKUP/XLOOKUP or equivalent) for reconciliation and reporting., • High attention to detail, documentation discipline, and ability to work independently in a program with new and evolving guidance., • High school diploma or GED required. Preferred Qualifications • Direct experience billing County of San Diego BHS / ShortDoyle MediCal., • Familiarity with CalAIM, BHCONNECT, per diem or bundled rate reimbursement models, or psychosocial rehabilitation programs (Clubhouse model a plus)., • Certified Professional Biller (CPB), CRCR, or equivalent credential., • Experience standing up billing operations for a new program or contract., • Bilingual English/Spanish. Compensation & Benefits • Hourly range: $24 – $26, • 160 Hours of Paid Time Off (PTO), • 12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment, • 4 Paid Volunteer Hours per Month to support causes you care about, • Bereavement Leave, including Fur Baby Bereavement, • 90% Employer-paid Employee-Only Medical Benefits, • Dental and Vision Insurance, • FSA | Dependent Care Account, • 401(k) with Company Match, • Monthly Stipend, • Short-Term & Long-Term Disability | AD&D, • Employee Assistance Program (EAP), • Employee Discounts via Great Work Perks and Perks at Work, • Quarterly In-Person Events, • Fully remote work within California, • Opportunities for professional development and internal growth Work Environment • Remote, • Monday - Friday 8:30 am - 5 pm Equal Employment Opportunity Pacific Health Group is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, ancestry, age, disability, medical condition, genetic information, marital status, military or veteran status, or any other characteristic protected by federal, state, or local law. Pacific Health Group will provide reasonable accommodations to qualified individuals with disabilities in accordance with the ADA and California FEHA.