Billing Coordinator I

Planned Parenthood of the Pacific Southwest; San Jose (CA); Hybrid; USD 30,000 - 39,000; Full time

Job summary

Planned Parenthood of the Pacific Southwest is seeking a medical billing professional to review payer claims and ensure charges align with guidelines. The role involves processing unbilled charges, clearing claim edits, and submitting claims on time with accuracy.

You will assist in handling inquiries, manage payer notifications, and rebill according to corrections. This position may require onsite work near the administrative office and supports a HIPAA-compliant environment.

Qualifications

• High School Diploma required.

Responsibilities

• Review governmental and non-governmental payer claims for accuracy and ensure billing charges comply with payer-specific guidelines.
• Work daily unbilled charge reports to identify discrepancies, process charges, and submit claims according to established processes and workaids.
• Monitor and resolve claim production red edit reports daily to clear edits and coordinate corrections with health center staff for timely submission.
• Review and resolve rejected claims queues in the clearinghouse to transmit claims per workaids and department expectations.
• Respond to billing-related inquiries from health center staff to expand knowledge of issues and resolutions methods.
• Process incoming correspondence for the assigned health centers, including payer notifications, returned claims and rebill to corrected claim.
• May report onsite when required and perform additional duties and special projects near the administrative office.
• Meet department productivity and claim submission KPIs and benchmarks and adhere to policies and timelines.
• Maintain confidentiality of patient and organizational information per HIPAA regulations.

Education

High School Diploma

Tools

Microsoft Word

Microsoft Excel

Job description

• Review governmental and non-governmental payer claims for accuracy and ensure billing charges comply with payer-specific guidelines.
• Work daily unbilled charge reports to identify discrepancies, process charges, and submit claims according to established processes and workaids.
• Monitor and resolve claim production red edit reports daily, to clear edit, coordinate with health center staff for corrections and ensure timely claim submission.
• Review and resolve rejected claims queues in the clearinghouse to transmit claims per workaids and expectation set by department.
• As assigned, respond to billing-related inquiries from health center staff to expand knowledge of issues and resolutions methods.
• Process incoming correspondence for the assigned health centers, including payer notifications, returned claims and take appropriate action to resolve and rebill to the corrected claim.
• May need to report onsite when required and perform additional duties and special projects, if closer to the administrative office.
• Must meet department’s productivity and claim submission benchmarks and billing Key Performance Indicators (KPIs) and benchmarks.
• Adhere to departmental policies, procedures, billing guidelines, productivity expectations, and established timelines.
• Maintain confidentiality of patient and organizational information in accordance with HIPAA regulations.
• For remote work arrangements, maintain a secure, organized, and HIPAA-compliant work environment that supports productivity and protects confidential information.
• Perform other duties and special projects as assigned

Serve as backup for other employees for breaks and absences as needed

Perform other duties as assigned

Qualifications

High School Diploma required

Knowledge of professional claims billing or one to two years of experience in medical billing.

• Ability to manage multiple tasks/projects simultaneously and adapt to frequent priority changes
• Good writing, editing and communication skills with attention to detail and accuracy
• Knowledge of Medi-Cal, State Programs & Commercial Insurance (HMO, PPO, EPO, etc) preferred
• Basic proficiency in Microsoft Word and Excel
• Must adhere to all HIPPA guidelines and regulations and maintain patient and organization confidentiality.
• Must follow affiliate policies and procedures

Equal Opportunity Employer
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