Job description

Job Title: Medical Biller/Patient Representative/Reimbursement Specialist II
Location: San Ysidro, CA
Duration: Direct Hire

Job Description
The Reimbursement Specialist II is responsible for the complete revenue cycle including billing medical, dental, and/or hospital claims. They are responsible for payer follow-up and appealing denied encounters to ensure the accuracy of reimbursement.

Essential Functions of the Job:

• Prepares accounts and encounters for accuracy for billing.
• Prepare, review, and transmit claims using automated systems and manual paper claim processes.
• Provides any required attachments to third-party claims including authorizations and EOB to ensure timely payment for the third-party payer.
• Changes system financial settings once primary insurance has been paid to ensure that co-payments and deductibles are generated to guarantors.
• Identify and bill secondary payers.
• Ensures accurate calculation of disallowances and adjustments through analysis of SYHealth contracts, Medicare, and Medi-Cal reimbursement schedules and rates.
• Performs adjustment write-off (s) keying and posting via computer input after obtaining approval signatures if required.
• Performs timely follow-up on unpaid claims using the system work list and/or Remittance Advice, EOBs, and other payment documents.
• Documents all analysis findings, phone calls, and correspondence in the online practice management system.
• Respond to all patient or insurance telephone inquiries to ensure timely reimbursement.
• Must maintain assigned Accounts Receivable at or below goal on a consistent basis.
• Attends meetings and training classes as required by departmental or facility management.
• Will be called upon to perform special projects and participate in internal and external audits that may require some evening and weekend hours.
• Adheres to established departmental and facility policy and procedures, objectives, quality assurance programs, safety, and infection control standards.
• Functions as a resource on assigned Accounts Receivable category to all staff and may assist with training.
• Attends training required by the State or Federal Government and Insurance plans to insure compliance with billing rules and regulations.
• Must be well versed and up to date in all billing rules and regulations to ensure compliance with federal and state laws.
• Must be able to track denials for the purpose of denials trending and management to report back to management.
• The ability to read and interpret contract language is an essential function of the reimbursement specialist II.
• The reimbursement specialist II must be able to successfully prepare an appeal for denial and receive accurate reimbursement.

Additional Duties and Responsibilities:

• Any and all duties as assigned by the Director of Revenue Cycle, Business Office Manager, or Billing Supervisors.

Education Required (Minimum level of education):

• High School Diploma or GED equivalent.
• Some colleges preferred.

Certifications/Licenses Preferred:

• Certificate of completion of Billing and/or Coding.

Experience Required (Minimum level of experience):

• The Specialist II must have a minimum of 3 years of experience in a medical billing department.
• Must also demonstrate knowledge of CPT, HCPCs, and ICD-10 coding as well as Medical Terminology.

Verbal and Written Skills Required to Perform the Job:

• Good oral and written communication skills.
• Provides positive customer service skills.
• Must possess the ability to communicate effectively in English; both verbally and in all written communication in order to write appeals to payers.

Technical Knowledge and Skills Required to Perform the Job:

• Experience in billing, CPT codes, and ICD-10, as well as Medical terminology.

Equipment Used:

• Computers, Software systems, Scanner, telephone, Copy, and Fax machines.

Working Conditions and Physical Requirements:

• Sedentary work requires sitting and the use of the PC most of the day.

Job Type: Full-time

Salary: $20.00 - $24.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Experience:

• ICD-10: 1 year (Preferred)
• CPT coding: 1 year (Preferred)

Work Location: One location

Speak with the employer
+91 973-302-3363

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