Billing Specialist Job at PLANNED PARENTHOOD NORTHERN CALIFORNIA
SUMMARY
Ensures errors on third party billing from system generated error reports are corrected prior to submission of claims to third party payers and works denials from third party payers in order to resubmit claims for payment. Responsibilities can include daily receipts, processing the 835 Electronic Remittances, take daily incoming calls and any related customer service needs. Maintain a working knowledge of health care plan requirements and health plan networks.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned as needed.
Answer technical questions from Health Center staff regarding billing, patient eligibility, payer benefits and services covered, data entry, and other payer requirements.- Working knowledge in the areas of Medi-Cal, Managed Care, Medicare, and Commercial payers preferred.
- Analyzes and processes third party Remittance Advice Details and determines appropriateness of resubmitting denied claims within specific limits of payers.
- Posts payments from third party payers.
- Contacts insurance companies, as necessary, to resolve payment, denials and billing issues.
- Identifies and communicates effectively in verbal and written format the errors found in the billing and reports them to the Billing Supervisor.
- Completes claim and appeal inquiry forms to payers.
- Works daily error reports and completes claim corrections.
- Works daily Worklog tasking, aging and rebill reports, appeals and follow up to ensure payment of claims.
- Ensure accuracy and completeness of data entered and verifies accurate billing.
- Performs a variety of clerical tasks for the billing dept., including filing, and sorting, posting or copying.
- Active participation in the advancement of PPNorCal’s Diversity, Equity, and Inclusion commitment.
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
- One year medical billing certificate from college or technical school; plus minimum one year related experience and/or training (could include min. one year experience as a RHS III at PPNorCal); or equivalent combination of education and experience.
- Experience working with practice management systems (preferably NextGen/EPIC) and third party billing/coding, especially with Medi-Cal.
LANGUAGE SKILLS
Ability to read and interpret documents such as medical billing manuals, operating and maintenance instructions and procedure manuals (NextGen/EPIC). Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
REASONING ABILITY
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
COMPUTER SKILLS
To perform this job successfully, an individual should have knowledge of database (NextGen/EPIC), Internet, spreadsheet (Excel) and word processing (Word) software.
PROTECTED HEALTH INFORMATION (PHI) ACCESS REQUIREMENT
As required for patient billing requirements.
CERTIFICATES, LICENSES, REGISTRATIONS
N/A
OTHER SKILLS, ABILITIES AND QUALIFICATIONS
- Demonstrated proficiency in the organization’s practice management system including the ability to be a resource for staff regarding basic trouble shooting, building profiles, triaging technical problems and utilizing resources as needed.
- In-depth knowledge of CPT, HCPCS, ICD-10-CM coding and various payer sources, especially Medi-Cal.
- Acceptance and application of the confidential nature of the position.
- 10-key proficiency by touch.
- Strong communication (verbal and written), decision-making, time management and organizational skills.
- Must have the willingness and ability to adapt to change including advances in technology.
- Must have excellent customer service skills and be committed to providing the highest level of customer satisfaction.
- Must continuously demonstrate ability to work effectively, cooperatively, and harmoniously with co-workers and others encountered in the course of the job.
- Must be counted on to complete assigned duties. Must be punctual and maintain regular attendance with minimum number of unplanned absences.
- High level of accuracy and attention to detail.
- Ability to prioritize work and to manage shifting and multiple projects and priorities in a fast paced, growth environment.
- Ability to sit and concentrate for extended periods of time.
- Ability to work independently and as part of a team.
- Commitment to quality health care.
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