Medical Billing Specialist

Job Locations US-CA-Anaheim
Posted Date 2 months ago(7/15/2021 11:35 AM)
Job ID
2021-2255
# of Openings
1
Category
Finance/Accounting/Purchasing

Overview

Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for a Medical Billing Specialist in Anaheim, CA responsible for ensuring the timely submission of medical claims to insurance companies, including physician offices, payers, medical groups or other healthcare facilities and certifies clean claim, charge posting and billing to obtain accurate reimbursement for healthcare claims.

 

At PPOSBC, we understand the importance of a well-rounded benefits program and are dedicated to providing you with unique benefits that meet the needs of you and your family. We are proud to offer a range of plans that help protect you in the case of illness or injury including:

  • A competitive benefits package including medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability. 
  • Benefits coverage starts after one full month of employment!
  • Generous vacation, sick, and holiday benefits!
  • Generous 401(k) matching contributions and more!
  • To view our detailed benefits guide, please visit our career site at www.pposbccareers.org

Responsibilities

Essential Functions:  Essential functions encompass the required tasks, duties and responsibilities performed as part of the job and the reason the job exists.

  • Serves as a liaison between management and the billing team
  • Reviews appropriate documents for billing accuracy, corrects order code (appointment type), Billing Policy for instructions, financial class, demographics, medical records, proper physician information for billing requirements, place/date of service, and notes to determine accurate creation of the patient’s encounter.
  • Reviews and monitors day to day productivity to ensure that billing deadlines are met.
  • Maintains in-depth knowledge of payer regulations and reimbursement methodologies to assure accurate reimbursement.
  • Keeps abreast of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding.
  • Maintains a billing accuracy percentage of 95% to ensure clean claims submission.
  • Compiles billing and payer documentation to assist management in training tools.
  • Communicates with RCM leadership about payer updates, changes, and requirements.
  • Reviews claims to ensure that billing data adheres to governmental and state requirements for all Family Planning billing including surgery claims.
  • Ensures that all required signatures and authorizations are in place prior to submission.
  • Handles information about patient treatment, diagnosis, and related procedures to ensure clean claim submissions.
  • Reviews patient bills for accuracy and completeness, and obtains any missing information.
  • Prepares, reviews, and transmits claims using billing software, including electronic and paper claims processing.
  • Maintains knowledge levels of payer changes as they occur.
  • Validates eligibility and benefits verification to ensure that claims are billing to appropriate payer.
  • Uses computers to read and organize charts.
  • Ensures healthcare facilities are reimbursed for all procedures.
  • Posts and manages patient account payments.
  • Submits claims to insurance within corporate charge posting lag.
  • Follows up on claim submissions to determine batch acceptance, rejection, or denial.
  • Researches, corrects, resolves, resubmits rejected or errored claims/services.
  • Corresponds with insurance companies to resolve issues.
  • Communicates with RCM leadership about payer updates, changes, and requirements.
  • Reviews delinquent accounts and calls responsible party(ies) for collection purposes.
  • Investigates insurance fraud and reports if found.
  • Maintains strict confidentiality.
  • Regularly attends monthly staff meetings and continued educational sessions as requested.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Minimum Education:

High school diploma or Associate’s preferred or equivalent experience in related field.

 

Minimum Work Experience:

  • A minimum of 3-5 years of experience as a medical biller in an outpatient medical setting (non-hospital) family planning, ob-gyn, and related surgeries required.
  • A minimum of 3-5 years of experience with electronic practice management system and electronic health record system.
  • Advanced knowledge of medical terminology and common industry abbreviations, anatomy and physiology, pharmacology, and pathophysiology.
  • Advanced knowledge of coding guidelines, policies and procedures
  • Computer database management (electronic practice management system). EClinicalWorks / NextGen experience preferred.
  • A minimum of 3-5 years of in medical insurance billing and coding procedures.
  • A minimum of 3-5 years of with insurance billing and reimbursement procedures.
  • A minimum of 3-5 years of with HIPAA 5010 transaction standards.

Language Requirements/Preference: Some positions require bilingual skills (reading, writing, and speaking).  If required, candidate will be tested for proficiency prior to job offer.

 

Other Requirements:

  • Ability to apply coding guidelines to billing guidelines to validate appropriate billing
  • Ability to read and interpret insurance eligibility to determine payer responsibility.
  • Demonstrate a strong knowledge of the payer contracts and DOFR to ensure that claims are sent to the correct payer.
  • Strong knowledge of Family Planning, Medi-Cal, Commercial, Medi-Cal Managed Care and Primary Care billing.
  • Familiarity with medical terminology.
  • Availability to work flexible hours including weekend.

All employees are required to be fully vaccinated for COVID-19 unless a reasonable accommodation is approved for a medical/disability or religious exemption.

 

Planned Parenthood/Orange and San Bernardino Counties is an equal opportunity employer. Applicants will receive consideration for employment without regard to race, color, ancestry, national origin, religion, creed, equal pay, age, disability, sex, gender, sexual orientation, gender identity, gender expression, medical condition, genetic information, marital status, military, veteran status or any other federal or state protected class. We are committed to building and maintaining an inclusive workplace that values diversity, equity, and inclusion.

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