Medical Biller - Remote Position (multiple openings)

Medical Biller

Job Summary:

The Medical Biller at Vigilance Health plays a critical role in ensuring accurate and timely processing of billing encounters, compliance with healthcare regulations, and continuous improvement of billing practices. The individual in this position is expected to work closely with the Billing Lead, Revenue Cycle Director, and other team members to maintain high standards of billing accuracy and timeliness.

Essential Duties and Responsibilities:

• Processing Daily Billing Encounters (35%)

• Ensure that encounters for services provided by Care Managers are processed daily with a focus on accuracy and compliance with billing standards.

• Core Value Alignment: Building Solutions - Process encounters efficiently to contribute to the organization's financial health and stability.

• Charge Entries Proofing and Posting (20%)

• Daily proofing and posting of charge entries with a high level of attention to detail to ensure billing accuracy.

• Core Value Alignment: Having Fire - Approach each task with enthusiasm and commitment to excellence.

• Eligibility and Benefits Verification (15%)

• Regularly check eligibility and verify benefits for chronic care management services, ensuring compliance with payer requirements.

• Core Value Alignment: Being Driven - Stay proactive in verifying patient information to prevent delays or errors in billing.

• Communication with Billing Lead and Revenue Cycle Director (10%)

• Regular communication with key stakeholders to resolve billing issues promptly.

• Core Value Alignment: Being Partners - Foster collaboration and effective communication to ensure seamless operations.

• Billing Clean Claims Daily (15%)

• Responsibility for billing clean claims daily to payers, maintaining department and billing standards.

• Core Value Alignment: Building Solutions - Ensure claims are processed correctly the first time, reducing rework and improving cash flow.

• Team Participation (5%)

• Active participation in daily team huddles and other relevant meetings to align with team goals and updates.

• Core Value Alignment: Being Coaches - Engage with the team to share knowledge and contribute to collective success.

Key Performance Indicators (KPIs):

1. Accuracy of Billing Encounters:

• Target: 98% accuracy in daily billing encounters.

• Measurement: Monthly audit reports on billing accuracy.

1. Timeliness of Charge Entries:

• Target: 100% of charge entries proofed and posted daily.

• Measurement: Daily performance logs.

1. Eligibility Verification Turnaround:

• Target: Eligibility and benefits verification completed within 24 hours of service.

• Measurement: Weekly performance reports.

1. Resolution of Billing Issues:

• Target: Resolve 95% of billing issues within 48 hours.

• Measurement: Issue resolution logs.

1. Clean Claims Submission Rate:

• Target: 99% of claims submitted clean on the first attempt.

• Measurement: Monthly claims submission reports.

1. Team Engagement:

• Target: Active participation in 90% of daily huddles and meetings.

• Measurement: Attendance and participation records.

Minimum Education and/or Work Experience Requirements:

Proficient in FQHC/CHC/RHC billing

Experience with EHR system (Preferably eCW, EPIC, Athena, NextGen)

Knowledge of Health care third party reimbursement programs; such as Medicare, Medi-Cal, Managed Care

Health Plans, or private insurance

Should be independent and self-motivated yet eager to work with others, and must demonstrate strong

presentation skills

Ability to accomplish / complete tasks while demonstrating a high level of attention to detail

Desired Skills / Experience:

- Superior Critical Thinking Skills

- Results Oriented and have a high level of integrity and dependability

- Strong interpersonal and communication skills

- Time Management

- Basic computer skills, with proficiency in Microsoft Office

- Organized

- Proactivity and Self-Motivation - Flexible - Problem solver - Decision making - Demonstrate attention to detail - Ability to independently carry out varied responsible billing assignments Other: - Quiet and free of distractions work area - Reliable and fast internet connection to access VPN - Comfortable working in a remote position - Ability to work 8-hour shifts

Core Values

• Having Fire

• Being Driven:

• Being Partners

• Building Solutions

• Being Coaches