Finance Specialist II - Medical Billing and Customer Service

Description

JOB SUMMARY:  Under general supervision of the Director of Finance, provides a variety of medical billing and coding duties for a variety of our medical programs according to departmental, professional, and regulatory standards.  Works collaboratively with specific program team to ensure appropriate agencies, reports, policies and procedures are engaged.

ESSENTIAL DUTIES & RESPONSIBILITIES:

Billing & Coding

1. Ensures invoices, claims, and payments are processed within department, program, and contractual requirements.
2. Coordinates with the Third-Party Administrator (TPA), if applicable, to track claims and ensure proper payment of claims through precheck process.
3. For programs that do not utilize a TPA, submit claims for processing and payment via applicable billing system.
4. Prepares files to post to post in MIP Fund Accounting system, pulls claims for payment, match EOB’s, select invoices to be paid, and print checks weekly.
5. Processes month end accruals of claims received, but not processed.
6. Serves as point of contract for providers and internal staff on status of payments, claim errors, and missing authorizations.

General/Other

1. Work collaboratively with other team members and participate as an active member of the Finance team when appropriate.
2. Function as key point person to work collaboratively with participants and PACE team members during private pay transactions:
   1. Understand and ensure the private pay financial requirements related to enrolling and remaining in the program and will require the eligible participant to pay the capitation amount within timelines.
   2. Provide applicant with a receipt and review the Redwood Coast PACE billing procedures and answer any questions the applicant might have.
   3. Contact the participant, and/or the participant’s representative if Medicare premium is not received in full within 30 calendar days to inform him/her of the overdue amount.
   4. Follow established procedures and processes for Involuntary Disenrollment for Failure to pay Medicare Premiums.
3. Performs other general office duties including filing, copying, scanning, and preparing correspondence.
4. Contribute to a positive work environment by participating in solutions to problems as they occur.
5. Acts in a manner consistent with agency values

Qualifications

EDUCATION &/or EXPERIENCE:

1. Two years medical billing and coding experience preferred.
2. A combination of training and experience equivalent to an AS/AA degree in Accounting or Business Administration preferred.
3. Proven experience processing receivables and performing general accounting functions.

PRE-SCREENING REQUIREMENTS:

1. Requires clearance of a DOJ and FBI criminal history background check
2. COVID-19 and Influenza (flu) vaccines preferred.

JOB SKILLS:

1. Organize own work, set priorities and meet critical deadlines.
2. Knowledge of computerized accounting software.
3. Strong basic computer skills (Microsoft Outlook, Word, Power Point, and Excel). Ability to navigate, use, and maintain database software programs. Basic knowledge of web-based applications such as timekeeping, training, and email programs.
4. Use various client-oriented software to bill for client services.
5. Interpret and apply policies and procedures.
6. Excellent oral and written communication skills and be able to compose correspondence and reports independently or from brief instructions.
7. Establish, maintain, and research files.
8. Make accurate arithmetic and financial computations.
9. Quickly and accurately enter and retrieve computer data to perform assigned work.
10. Operate modern office equipment including computers, handheld equipment, and software programs.
11. Establish and maintain effective working relationships with employees and the public contacted in the course of work.

PHYSICAL REQUIREMENTS:

1. Ability to sit at a desk and interact with a computer screen for extended periods of time.
2. Hand and arm strength sufficient to operate a keyboard for several hours each day and reach for files, binders, and supplies as needed.
3. Ability to lift up to 10 pounds.

The above statements are intended to describe the general nature of work performed.  They are not considered as an exhaustive list of all job tasks performed.  The agency reserves the right to change job descriptions, work hours or work sites as required by the program.

The Humboldt Senior Resource Center is a private, non-profit, multi-purpose senior center providing a continuum of social and health related services. The agency currently holds contracts with the California Department of Aging and Area One Agency on Aging.

The Humboldt Senior Resource Center is an equal opportunity employer.  We will not unlawfully discriminate against qualified applicants or employees with respect to any terms or conditions of employment based on race, color, national origin, ancestry, sex, sexual orientation, age, religion, physical or mental disability, medical condition, pregnancy, breastfeeding, gender identity, marital status, citizenship status, military or veteran status, genetic information, or other basis protected by applicable federal or state law.

Salary : $21 - $23