Billing Rep Lead

Dignity Health Medical Group; Rancho Cordova (CA); On-site; USD 30,000 - 39,000; Full time

Job summary

CommonSpirit Health is seeking a Billing Rep to support patients and providers in streamlining the billing and insurance process, enabling focus on patient care and financial well-being.

As a Billing Rep, you will review and process patient accounts, insurance claims, and payment postings with accuracy and timeliness. You will follow up on denied claims and safeguard patient confidentiality while applying healthcare billing knowledge.

Qualifications

• Requires 5 years in healthcare Rev Cycle or a professional medical office.
• One year of experience with IDX Practice Management System.
• Knowledge of physician billing regulations.
• Understanding of professional claims and billing procedures; knowledge of government and insurance regulations.
• Excellent written and verbal communication skills.
• Must demonstrate judgment, initiative, and resourcefulness when dealing with internal and external customers.
• Demonstrated ability to provide leadership to others.

Responsibilities

• Review and process patient accounts, insurance claims, and payment postings to ensure accurate and timely billing.
• Follow up on denied claims and maintain patient confidentiality.
• Analyze accounts receivable, payer denial trends, and identify training needs for staff.
• Research and resolve complex issues with payors and ensure compliance with workflows.
• Maintain audit scores and meet turnaround times.
• Collaborate with A/R Billing Supervisor to resolve discrepancies identified in audits.

Skills

Attention to detail

Healthcare billing knowledge

Communication skills

Leadership

Problem solving

Education

High School Diploma or GED

Tools

IDX Practice Management System

Job description

Job Summary and Responsibilities

As our Billing Rep, you will help our patients and providers streamline the billing and insurance process so they can focus on patient care and financial well-being.

Every day you will review and process patient accounts, insurance claims, and payment postings. You will be expected to ensure accurate and timely billing, follow up on denied claims, and maintain patient confidentiality.

To be successful in this role, you must have strong attention to detail, knowledge of medical billing and coding, and experience with healthcare insurance.

• Demonstrates a solid understanding of accounts receivable and your role as the A/R Billing Rep Lead to include: Payor Rules & Regulations; Understand Contract Language; CCI Coding Issues; Read and interpret DOFR; Comprehend how transaction affect account; Coordination of Benefits Rules; Offsets & Recoups; Ability to determine correct systems to locate pertinent info; IDX, Medical Records Systems, Insurance Payor Websites, Code Correct.
• Provide in-depth analysis of inventory to identify possible system issues, payer denial trends and areas for staff training development.
• Resolves claim edits
• Independently researches and analyzes complex issues/accounts with available resources and tools. This may include direct contact with payor to determine if staff actions(s) taken are in compliance with current workflows and policies.
• Maintains, tracks and compiles audit scores within the expected turn around time.
• Works directly with A/R Billing Supervisor to ensure compliance with billing regulations on all discrepancies identified in an audit.

Job Requirements

Required

• High School Diploma or GED
• Five (5) years experience working in healthcare Rev Cycle or a Professional Medical Office
• One (1) year experience with IDX Practice management system
• Knowledge of physician billing regulations
• Understanding of professional claims and billing procedures. Knowledge of Federal and State regulations applicable to Government and Insurance Collections
• Excellent written and verbal communication skills
• Must be able to use a high level of judgment, initiative, and resourcefulness when dealing with internal and external customers
• Demonstrated ability to provide leadership to others