Medical Claims Processor

Claims Processor

Position Summary

Perform billing functions for the various clinical components of the Clinic, serve as an expert for other Claims Processors’ in the department, and serve as back up for the Billing Manager to run various financial reports as needed by the CFO.

Essential Functions

Systems Processes: Ensure efficiency, accuracy and accountability of information and data. Perform claims processing functions in a timely and accurate manner.

1. Check “superbills” for accuracy prior to entering into the system.

2. Review and, as necessary, correct data entry and billing errors prior to transmission.

3. Bill payment source(s) within 48 hours of patient’s visit.

4. Post payment checks to appropriate accounts.

5. Research payment denials and re-submit for payment as necessary.

• Check count of “superbills” against daily log to ensure that every patient’s visit related paperwork has been received, posted and billed
• Prepare month end reports.
• Look up CPT and ICD-10 codes for accurate coding.
• Perform weekly transmission of claims.
• Update daily error reports for clinic/nurse managers.

Communications: Ensure effective, professional communications within and outside of the Clinic setting.
11. Communicate effectively with all levels of staff and volunteers.

12. Consistently utilize/facilitate effective strategies to communicate pertinent information in a timely manner.

13. Through teamwork and accountability exhibit behaviors and attitudes of courtesy and respect for all members of the Division/Work unit in accordance with Clinic’s mission and values.

• Maintain high level of respect and confidentiality in handling all patient information at all times.

15. Provide input to supervisor on areas or issues to improve the running of the billing functions.

Regulatory Compliance: Ensure compliance with regulatory agencies, contractual obligations and funding sources.

16. Perform functions, duties and /or services in compliance with regulatory agencies, contractual obligations, funding sources and any and all laws governing area of expertise.

17. Maintain records/documents in accordance with policies and procedures, regulations, contractual obligations and funding sources.

Other Functions:

18. Other responsibilities as assigned by supervisor.

Physical Activity: Perform all or some of the following tasks during the work day: reading, writing, speaking, listening, typing and sitting for long periods of time working extensively with computers, standing and walking.

Equipment Used: personal computer, telephone, copier, fax machine, calculator

Position Requirements: These are general guidelines based on the minimum experience normally considered essential to the satisfactory performance of this job. Individual abilities may result in some deviation from these guidelines.

To perform effectively in this position, the incumbent must have:

· Medical Billing Certification and two (2) years experience as a Biller or Collector. Extensive knowledge of medical terminology, billing procedures, CPT and ICD-10 codes.

· Medicaid/Medi-Cal, CHDP, Managed Care and other medical, dental, health insurances reimbursement procedures preferred.

· Ability to accurately utilize personal computer. Proficiency with Microsoft Office (Word, Excel and Outlook.)

· Demonstrated proficiency in written and spoken English required.

· Handle patient information with utmost respect and confidentiality.

· Ability to work as part of a team and independently

· Must demonstrate excellent telephone and customer relations skills.

· Willingness to commit to the philosophy and goals of Celebrating Life Community Health Center.

The incumbent must be able to perform this job safely, without endangering the health or safety of him/herself or others.

Job Type: Full-time

Pay: $19.00 - $23.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• ICD-10: 1 year (Preferred)

Ability to Relocate:

• Mission Viejo, CA 92691: Relocate before starting work (Required)

Work Location: In person