Billing Specialist - Billing Department

Job Overview

The Billing Specialist is responsible for managing HealthRIGHT360’s clinical database/billing system, including e-Clinical works (ECW) or any other future EMR’s reconciling insurance claims and tracking UDC’s/UOS for HealthRIGHT 360’s medical contracts.

Key Responsibilities

Billing Responsibilities: Under the supervision of HealthRIGHT360’s Revenue Cycle Manager Manager, the billing specialist is responsible for accurate and timely scanning of EFT’s, checks, EOB’s, claim Inquiries, denials, RTD’s and correspondence to PMG or other entities.  The position is responsible by obtaining any additional information that may be needed to complete claims (Dx codes, CPT codes, note signatures, etc). Maintain and ensure proper coding for encounters including updates of ICD-10 and CPT codes.

Bank Statement Reconciliations. Weekly Reconciliation the front desk cash logs, co-payments, and deposits to EMR and turn into fiscal. Along with the Revenue Cycle Manager and Directors of Operations investigate, post, and manage EMR payments and deposit into bank.

Under the direction of the Revenue Cycle Manager develop and manage electronic billing system by inactivating and adding new/discontinued CPT and ICD10 codes, updating the Federal Poverty Level, Sliding Scale Fees and Charges on an annual basis.

Regular management of HealthRIGHT 360’s Medical Program’s funding sources, including Medi-Cal, Medicare, Family PACT, Managed Care and Commercial Insurances.

Daily management of Return to Clinic (RTC) errors.

Daily processing of clinic/billing mail and work with PMG and Internal billing department to process ACH, remits, etc. and scan/upload to appropriate folders for processing.

Under supervision of the Revenue Cycle Manager process patient refunds as necessary.

Billing Credentialing: 

Notify PMG of all termed/hired employees. Obtain all provider materials needed for credentialing providers with all payer sources. Work with PMG on outstanding AR.

Compliance Responsibilities: Ensure clinic stays in compliance with billing requirements (i.e. Medi-Cal/Medicare/HRSA compliance).

Assist Medical Records department in providing billing records for patients upon request.

Customer Service: Work directly with patients and Revenue Cycle Manager to address patients concerns or billing or statement concerns. As requested work with patients to explain the breakdown of fees and collect payment.

And, other duties as assigned.

Education and Knowledge, Skills and Abilities

Education and Experience Required:

• Associates Degree in related field.
• Certificate in Medical Terminology or Billing and Coding. 
• 2 years of experience in accounting or billing department.
• Strong verbal communication.
• Proficient in Excel.
• Strong attention to detail.
• Excellent time management skills.
• Ten key experience.
• Data entry experience.
• Experience using billing software; eCW, Epic, and ClaimRemedi preferred.

Desired:

• Bachelor’s Degree in Accounting or related field

Background Clearance Required:

• Must not be on active parole or probation 

Knowledge Required:

• Excellent command of spreadsheet applications.
• Culturally competent and able to work with a diverse population.
• Strong proficiency with Microsoft Office applications, specifically Word, Excel, Outlook and internet applications.

Skills and Abilities Required:

• Ability to enter data into various electronic systems while maintaining the integrity and accuracy of the data.
• Professionalism, punctuality, flexibility and reliability are imperative.
• Excellent verbal, written, and interpersonal skills.
• Integrity to handle sensitive information in a confidential manner.
• Action oriented.
• Strong problem-solving skills.
• Excellent organization skills and ability to multitask and juggle multiple priorities.
• Outstanding ability to follow-through with tasks.
• Ability to work cooperatively and effectively as part of interdisciplinary team and independently assume responsibility.
• Strong initiative and enthusiasm and willingness to pitch in whenever needed.
• Able to communicate well at all levels of the organization including working with organization leadership and high-level representatives of partner organizations.
• Able to work within a frequently changing project scope while maintaining overall direction and structured priorities.

Desired:

• Bilingual.

In compliance with the California Department of Public Health's mandate, all employees must be able to provide proof of COVID-19 vaccination. Medical and religious exemptions are available.

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