Job Details Level: Experienced Job Location: CMC Weberstown - Stockton, CA Position Type: Full Time Education Level: High School Salary Range: $22.50 - $25.93 Hourly Job Shift: Day Job Category: Health Care
POSITION SUMMARY: The Billing Specialist II assists in maintaining the billing systems. The Billing Specialist II reports to the Revenue Cycle Director or department supervisor as assigned.
SPECIFIC DUTIES:
- Responsible for maintaining the clinic billing of all patients to include charges, payments, adjustments, and any follow-up necessary for Self-Pay, Medi-Cal, Medicare, and third-party payers.
- Reviews patient chart documentation to assure correct coding and accurate billing.
- Analyzing patient medical records to determine billable services based on payer guidelines that include Medi-Cal, Medicare, Commercial, and State Specialty Programs.
- Evaluate the accuracy of pending charges including dates of service, procedure, location, ICD-10 CM, CPT, CPT II, CDT, HCPCS Codes and modifiers.
- Ensure timely and accurate charge submission through electronic EHR charge capture.
- Review first initial claim scrub before billing utilizing the practice management software.
- Importing of Electronic payments from third party payers that include Medi-Cal, Medicare, Commercial, and State Specialty Programs.
- Perform quality control of data entry to verify proper balancing/posting of payments to claims with accuracy and timeliness.
- Runs reports that require monitoring of unpaid claims with the appropriate payer in an effort to collect outstanding claims.
- Ability to research, analyze, and identify billing errors in detail quickly and independently and follow-up by rebilling denied and rejected claims in a quickly and on a timely manner.
- Actively participates in conversations with Revenue Cycle Director or designee to discuss any billing challenges.
- Verifying eligibility for third party payers that include Medi-Cal, Medicare, Commercial, and State Specialty Programs.
- Independently performs follow-up procedures as necessary for all third party payers including Medi-Cal Medicare, and self-pay patients’ questions.
- Writes off credit balances as appropriate.
- Compares insurance files with family insurance files to determine appropriateness of out-of-balance.
- Provides requested information for patient subpoenas.
- Collaborate closely with Center Managers, clinical support staff, and providers with pending charge acceptance corrections.
- Answer billing and charge related inquiries by patients, CMC staff, and third-party payers.
- Runs various types of reports as needed.
- Performs other duties as assigned.
MINIMUM REQUIREMENTS:
- High school graduate or possession of a GED and three years of experience OR AA degree and one year of experience. Experience required should be focused on progressive billing experience in a clinic or hospital setting. Federally Qualified Health Center experience is preferred. Billing certificate is preferred.
- Knowledge and experience utilizing medical terminology, ICD-10 CM, HCPCS and applying CPT coding rules.
- Ability to use 10-key, ability to type 45 wpm, applicant to provide typing certificate.
- Experience and knowledge of computerized medical or dental billing systems.
- Valid California Driver's license, proof of insurance, and personal transportation.
KNOWLEDGE, SKILLS, AND ABILITIES:
- Advanced knowledge of billing practices.
- Knowledge of clinic policies and procedures.
- Knowledge of coding and clinic operating policies.
- Advanced knowledge of Electronic Health Records, Electronic Practice Management, Excel, and Microsoft Word.
- Skill in using computer and calculator.
- Ability to examine documents for accuracy and completeness.
- Ability to prepare records in accordance with detailed instructions.
- Ability to work effectively with patients and co-workers.
- Ability to communicate effectively in verbal and written format.
- Listens skillfully and displays a willingness and ability to acknowledge the needs, expectations and values of others through the use of reflective listening and empathy conveyance. Responds to needs in ways that are helpful and beyond expectation.
- Communicate effectively by using welcoming words, proper tone of voice, appropriate body language, eye contact and smiling with every interaction.
- Ability to provide excellent customer service that is reflective of a culture that values trust and respect.
TYPICAL PHYSICAL DEMANDS: Requires sitting for long periods of time. Working in office environment. Some bending and stretching required. Working under stress and use of telephone required. Manual dexterity required for use of calculator and computer keyboard.
TYPICAL WORKING CONDITIONS: Work is performed in an office environment within a clinic setting. Involves frequent contact with staff and the public. Work may be stressful at times. Contact may involve dealing with upset people.
Community Medical Centers is an Equal Opportunity Employer. It is CMC’s policy to provide equal employment opportunities to all persons, regardless of age, race, religion, color, national origin, sex, political affiliations, marital status, non-disqualifying physical or mental disability, sexual orientation, membership, or non-membership in an employee organization or on the basis of personal favoritism or other non-merit factors except where otherwise provided by law.
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