Job Description

Job Description

Job Description

About Company:

At Pioneers, we pride ourselves on fostering a culture where every team member’s contribution is valued. As a valued member of our team, you will play a key role in providing excellent healthcare in the Imperial Valley, and you'll have the opportunity to work alongside a talented team in an environment that encourages professional development and continuous learning.

If you’re looking to bring your healthcare skills to an organization that values creativity, collaboration, and growth, then we want to hear from you!

About the Role:

SUMMARY:

This position is responsible for supporting the Professional Medical Billing team in reviewing and ensuring that patient records, accounts and payments for services rendered are managed with routine follow up. They will be responsible for monitoring and reconciling patient accounts and claims in the electronic health record system and clearing house. Performing routine charge reconciliation, insurance appeals, payment posting, denials and eligibility.

ESSENTIAL FUNCTIONS:

• Assist with processing daily insurance claims via clearing house, checking for errors and resubmitting when necessary
• Assist with reconciling daily charges
• Assist with printing and submitting claims not accepted electronically
• Responsible for working queues in system daily to ensure accurate and timely billing
• Follows up on claims that have been submitted for payment for more than 45 days, for all payers
• Reviews insurance denials and trouble shoots claims errors as necessary to ensure claims are reconsidered and resolved timely
• Performs insurance appeals based off insurance denials in a timely manner
• Monitors unpaid medical claims pending patient response and contacts patients regarding billing and account information when necessary
• Assist with processing and posting patient and insurance payments, ensuring accuracy of inputted data
• Reading and Interpreting insurance explanation of benefits (EOB)
• Coordinate with healthcare providers and hospital staff in regards to encounters needing review to ensure accurate billing and timely completion of encounter corrections
• Update patient demographics and insurance plans when applicable
• Assist with sorting mail for insurance payments and denials, and patient payments
• Assist with answering phone calls, providing appropriate information to patient and/or insurance
• Assist with data entry for encounters
• Understanding of ICD-10, CPT Codes and HCPCS Level II Codes
• Other medical billing task as needed

OTHER RESPONSIBILITES:

• All other duties as required and assigned
• Ability to multitask and meet deadlines
• Utilize EMR/EHR, including patient accounting and registration systems to their full capacity
• Good written and verbal communication skills required for contacts
• Maintains records until follow up process is completed
• Maintain patient confidentiality as per Health Insurance Portability and Accountability Act (HIPAA)

SUPERVISOR RESPONSIBILITIES: NONE

EDUCATION, KNOWLEDGE, SKILLS, ABILITIES, AND EXPERIENCE:

• Education: high school diploma or equivalent required
• CPB certificate (but not required)
• At least one year experience working with Medicare, Medi-Cal, and Private Insurance
• Understanding and knowledge of payer edits and LCD/NCD guidelines
• Experience in the electronic and paper billing systems used in the medical billing health care system
• Close attention to detail and excellent problem solving skills
• Ability to use standard office equipment such a calculator, fax, copier, etc.
• Knowledge of Medical Terminology

LICENSES AND CERTIFICATIONS:

• CPB-AAPC (preferred but not required)

AGE OF POPULATION SERVED:

• No Patient Care

PHYSICAL REQUIREMENTS:

• Sitting for extended periods of time
• Stooping and bending required at times
• Dexterity of hands and fingers to operate a computer keyboard, mouse, phone system, etc.
• Some lifting of more than 25 lbs. may be required
• Computer entry

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