Billing Specialist I

POSITION SUMMARY:

The Billing Specialist I assist in maintaining the billing systems. The Billing Specialist I reports to the Revenue Cycle Director.

MINIMUM REQUIREMENTS:

• High school graduate or possession of a GED and one year of billing experience or a billing certificate.
• A billing certificate is not required but preferred. Work experience in a clinic or hospital setting or Federally Qualified Health Center is preferred.
• Ability to use 10-key, ability to type 35 wpm, applicant to provide typing certificate
• Experience and knowledge of computerized medical or dental billing systems is preferred
• Valid California Driver's license, proof of insurance, and personal transportation

SPECIFIC DUTIES:

• Responsible for maintaining the clinic billing of all patients to include charges, payments, adjustments, and any follow-up necessary for Self-Pay, Medi-Cal, Medicare, and third-party payers.
• Reviews patient chart documentation to assure correct coding and accurate billing.
• Analyzing patient medical records to determine billable services based on payer. guidelines that include Medi-Cal, Medicare, Commercial, and State Specialty Programs.
• Evaluate the accuracy of pending charges including dates of service, procedure, location, ICD-10 CM, CPT, CPT II, CDT, HCPCS Codes and modifiers.
• Ensure timely and accurate charge submission through electronic EHR charge capture.
• Review first initial claim scrub before billing utilizing the practice management software.
• Importing of Electronic payments from third party payers that include Medi-Cal, Medicare, Commercial, and State Specialty Programs.
• Perform quality control of data entry to verify proper balancing/posting of payments to claims with accuracy and timeliness.
• Runs reports that require monitoring of unpaid claims with the appropriate payer in an effort to collect outstanding claims.
• Ability to identify billing errors and follow-up by notifying the appropriate Supervisor regarding rejected claims to identify a plan of action to process rebilling.
• Verifying eligibility for third party payers that include Medi-Cal, Medicare, Commercial, and State Specialty Programs.
• Performs follow-up procedures as necessary for all third-party payers including Medi-Cal Medicare, and self- pay patients’ questions.
• Writes off credit balances as appropriate.
• Compares insurance files with family insurance files to determine appropriateness of out-of-balance.
• As requested, provides requested information for patient subpoenas.
• Collaborate closely with Center Managers, clinical support staff, and providers with pending charge acceptance corrections.
• Answer billing and charge related inquires by patients, CMC staff, and third-party payers.
• Runs various type of reports as needed.
• Performs other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Knowledge of billing practices
• Knowledge of clinic policies and procedures
• Knowledge of coding and clinic operating policies
• Ability to learn how to utilize Electronic Health Records and Electronic Practice Management systems.
• Knowledge of Excel and Microsoft Word
• Skill in using computer and calculator
• Ability to examine documents for accuracy and completeness
• Ability to prepare records in accordance with detailed instructions
• Ability to work effectively with patients and co-workers
• Ability to communicate effectively in verbal and written format
• Ability to provide excellent customer service that is reflective of a culture that values trust and respect.
• Listens skillfully and displays a willingness and ability to acknowledge the needs, expectations and values of others through the use of reflective listening and empathy conveyance. Responds to needs in ways that are helpful and beyond expectation.
• Communicate effectively by using welcoming words, proper tone of voice, appropriate body language, eye contact and smiling with every interaction.

TYPICAL PHYSICAL DEMANDS:

Requires sitting for long periods of time. Working in office environment. Some bending and stretching required. Working under stress and use of telephone required. Manual dexterity required for use of calculator and computer key­board.

TYPICAL WORKING CONDITIONS:

Work is performed in an office environment within a clinic setting. Involves frequent contact with staff and the public. Work may be stressful at times. Contact may involve dealing with upset people.

Community Medical Centers is an Equal Opportunity Employer. It is CMC’s policy to provide equal employment opportunities to all persons, regardless of age, race, religion, color, national origin, sex, political affiliations, marital status, non-disqualifying physical or mental disability, sexual orientation, membership, or non-membership in an employee organization or on the basis of personal favoritism or other non-merit factors except where otherwise provided by law.