Medical Billing & Claims Specialist

Talentify; Grass Valley (CA); On-site; USD 45,000 - 60,000; Full time

Job summary

Western Sierra Medical Clinic in Grass Valley, CA is seeking a Billing Specialist to submit insurance claims, monitor payments, and coordinate with providers and payers. The role reports to the Controller and operates as a non-exempt, full-time position.

Key duties include reviewing charges, identifying correct payers, coding and billing via HIT systems, credentialing with third parties, and processing claims with timely follow-up.

Qualifications

• High school diploma or equivalent; CMRS certification required.
• One year of current experience in a FQHC setting preferred.
• Computer literate with MS Office and data entry skills.
• HIPAA regulations knowledge and confidentiality.
• Familiarity with Medicare/Medicaid billing regulations.

Responsibilities

• Reviews patient charges for accuracy and completeness.
• Identify insurance company or proper party (patient) to be billed; identify and bill secondary or tertiary insurances.
• Perform coding and billing tasks on a computerized health information technology (HIT) system.
• Provider and facility credentialing with third party payers and maintenance of organized files and a credentialing progress grid.
• Third party payers contracting duties as assigned.
• Utilize a combination of electronic health record (EHR) and paper patient records to perform billing duties; maintain an accurate, legally compliant medical record.
• Process claims as they are paid and credit accounts accordingly.
• Review insurance payments for accuracy and compliance with contract discounts.
• Review denials or partially paid claims and work with the involved parties to resolve the discrepancy.
• Manage assigned accounts, ensuring that outstanding/pending claims are paid in a timely manner and contact appropriate parties to collect payment.
• Assist patients and staff in completing sliding fee applications and process the application in accordance with Western Sierra Board approved policy.
• Communicate with health care providers, patients, insurance claim representatives and other parties to clarify billing issues and facilitate timely payment.
• Consult supervisor, team members and appropriate resources to solve billing and collection questions and issues.
• Maintain work operations and quality by following standards, policies and procedures; elevate compliance issues to supervisor.
• Prepare reports and forms as directed and in accordance with established policies.
• Perform a variety of administrative duties including but not limited to: answering phones; faxing and filing of confidential documents; and basic Internet and email utilization.
• Provide excellent and professional customer service to internal and external customers.
• Function as contributing team member while meeting deadlines and productivity standards.
• Submit twice daily claims batches to all insurance carriers.
• Prepares insurance adjustments reports to Chief Financial Officer/Controller.
• Assists in insurance contract renewals and additions, as needed.
• Answer and direct phone calls.
• Documents all pertinent information in patient's electronic medical record according to WSMC's policies and procedures.
• Upholds WSMC's Policies and Procedures, infection control standards, applicable state, federal and local laws.
• Quality Improvement Duties: Participates in quality improvement activities; Participates as assigned in interdepartmental quality improvement team efforts; and Contributes to overall Community Health Center efforts in quality improvement towards higher-quality, more cost-effective health care for patients and improved quality of work-life for staff members.

Skills

Typing 45 wpm

MS Office

Data entry

HIPAA compliance

Medicare/Medicaid billing

Education

High school diploma or equivalent

CMRS certification

Tools

Ten-key calculator

Job description

Western Sierra Medical Clinic in Grass Valley, CA is seeking a Billing Specialist to submit insurance claims, monitor payments, and coordinate with providers and payers. The role reports to the Controller and operates as a non-exempt, full-time position.

Key duties include reviewing charges, identifying correct payers, coding and billing via HIT systems, credentialing with third parties, and processing claims with timely follow-up.