Billing Specialist

Socket.dev; Saint Paul (MN); On-site; USD 30,000 - 43,000; Full time

Job summary

Riverland Community Health in Saint Paul, MN seeks a Billing Specialist to manage the claims process, follow-up with payers, and support process improvements. You will ensure accurate claim creation and reconciliation of patient service payments from all sources.

The role requires knowledge of medical billing practices, strong customer service, and the ability to work both independently and within a team. HIPAA compliance and confidentiality are essential in a clinic environment.

Qualifications

• Strong customer service and communication skills.
• Experience with medical billing and insurance collections.
• Ability to work independently or in a team, with strong problem-solving skills.

Responsibilities

• Prepare and submit clean claims to third party payers electronically or by paper.
• Coordinate patient eligibility through third-party sources.
• Maintain and manage claim work queues and follow-up with payers.

Skills

Strong customer service

Excellent communication

Independent or team work

Medical billing practices

Spanish preferred

Education

High school diploma or GED

Post-secondary education preferred

Tools

EPIC experience

Job description

Description

Riverland Community Health is a Federally Qualified Health Center in St. Paul, where patients receive community-based Family Practice medical care in addition to mental health, dentistry, social work, and other integrated services. When joining RCH, you become part of a diverse, inclusive, and welcoming team who are dedicated to serving our patients and pursuing our mission to deliver excellent healthcare for all and training for the providers of tomorrow.

JOB SUMMARY:

The Billing Specialist manages the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries/correspondence. This position is responsible for assisting in the clarification and development of process improvements and inquiries; and assuring payments related to patient services from all sources are recorded and reconciled timely to maximize revenues.

ESSENTIAL FUNCTIONS:

Administrative Duties:

• Prepare and submit clean claims to third party payers either electronically or by paper.
• Coordinate the process of patient eligibility through various third-party sources.
• Maintain assigned Work Queues (WQ)
• Denial and insurance follow-up management.
• Issue adjusted, corrected, and/or rebilled claims to third party payers.
• Send collection letters to patients for past due amounts
• Assist in setting up payment plans with patients.
• Request insurance and patient refund.
• Maintain strict confidentiality; adhere to all HIPAA guidelines/regulations

Customer Service:

• Answer phone calls from patients and insurance companies.
• Return message left on the after-hours Business Office line.
• Explain benefits to patients.
• Respond to patient's inquiry on why insurance did not pay.
• Correspond with and provide updates to insurances.
• Identify and resolve patient billing problems.
• Take patient's credit card payments over the phone.

Perform other tasks as assigned.

Requirements

KNOWLEDGE, SKILLS AND ABILITIES:

• Strong customer service skills.
• Excellent written and verbal communication abilities.
• Ability to work independently or in a team.
• Skill in identifying problems, problem solving, and resolution.
• Ability to analyze patient accounts.
• Knowledge of basic accounting principles.
• Knowledge of medical billing / collection practices required.
• Knowledge of insurance requirements for third party payers, Medicare, and Medicaid.
• Demonstrate sound judgement and decision-making abilities.
• Ability to prepare and maintain detailed records, files, reports, and other correspondence.
• Ability to establish and maintain effective communication.
• Ability to perform the job in accordance with Riverland Community Health's Standards of Business Conduct, which includes compliance, ethics and integrity, confidentiality, protection of assets and avoidance of conflicts of interest and inappropriate business relationships. Specifically, work processes that involve billing/collections practices for avoiding activities that constitute fraud and abuse.
• Excellent time management skills with the ability to prioritize workflow and meet stringent deadlines.
• Basic computer skills.
• Strong keyboard skills.
• Bilingual-Spanish Preferred
• Previous FQHC preferred
• EPIC Experience preferred

EDUCATION/EXPERIENCE:

• High School Graduate or GED is required.
• Two years of post-high school education or degree preferred.
• Four years business office experience is required.
• Two years third-party payer billing experience is preferred.

CERTIFICATES, LICENSES, REGISTRATIONS:

• N/A

PHYSICAL DEMANDS:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

SUPERVISORY RESPONSIBILITIES:

• None

WORK ENVIRONMENT:

Work is performed in a clinic office environment. Contact with staff, patients and outside agencies. Possible exposure to communicable disease and medical preparations common to clinic environment.

A summary of our benefits include but are not limited to: health, dental, vision, HSA, FSA, basic life insurance, voluntary additional life insurance, spousal and child insurance, long-term disability, and a 403b retirement plan.

In addition, job offers made during flu season are conditioned on the candidate receiving the annual flu vaccination before their start date.

RCH is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Compensation is $21.50 to $31.50 hourly DOE