Medical Biller - Online Health Services

Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for a Medical Biller - Online Health Services in Anaheim, CA.

Schedule: Hybrid schedule

The Medical Biller - Online Health Services assures timely eligibility for appointments, working with OHS dashboard, billing and reimbursement of clean claims, corrects denied claims, appeals denied or delayed claims for OHS payers in order to receive reimbursement for healthcare claims. Responsible for verifying eligibility for online health appointments, working directly with OHS dashboard, creating patient accounts with patient demographics in EHR system, creating claims and billing to OHS payers with claims follow up.

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

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

• Knowledge of payer guidelines.
• Knowledge of industry standard and Medi-Cal denials reasons/codes.
• Knowledge of several different coding systems, including Level 1 HCPCS and Level 2 HCPCS.
• Understand and verify eligibility.
• Setup patient accounts in practice management system.
• Submit claims daily to insurances.
• Ensure all Online Health Services appointments are billed.
• Ensure Online Health Services are reimbursed at the correct rate for all procedures.
• Process payments from insurance companies.
• Follow up on claim submissions to determine batch acceptance, rejection, or denial.
• Follow up on claims in a timely manner
• Researches, corrects, resolves, resubmits and appeals denied claims/services.
• Corresponds with insurance companies to resolve the issue; submits appeals per payer requirements.
• Maintains collections rate for payers at or above 80% of allowed charges.
• 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.
• Other duties as assigned by Manager of Revenue Cycle Management.

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.

Licensure and/or Certification Requirements:

• Billing certificate preferred.

Minimum Education:

• Associates or Bachelor’s Degree preferred or equivalent experience in related field.

Minimum Work Experience:

• 2 years of experience as a medical biller/claims follow-up specialist or collections specialist in an outpatient medical setting (non-hospital) in primary care, family planning and telehealth.
• Medical terminology.
• Anatomy.
• Computer database management (electronic practice management system). EClinicalWorks/NextGen experience preferred.
• A minimum of 2 years of experience in Billing and coding procedures.
• A minimum of 2 years of experience with insurance billing and reimbursement procedures.
• A minimum of 2 years of experience with HIPAA 5010 transaction standards.
• A minimum of 2 years of experience claims follow-up/appeals and health plan Accounts Receivable management for specific payers

All employees are required to be fully vaccinated and received a booster 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.