Job Description

Billing Coordinator I

Full-Time (Hybrid)

ESSENTIAL DUTIES

• Review governmental and non-governmental payer claims for accuracy and ensure billing charges comply with payer-specific guidelines.


• Work daily unbilled charge reports to identify discrepancies, process charges, and submit claims according to established processes and workaids.


• Monitor and resolve claim production red edit reports daily, to clear edit, coordinate with health center staff for corrections and ensure timely claim submission.


• Review and resolve rejected claims queues in the clearinghouse to transmit claims per workaids and expectation set by department.


• As assigned, respond to billing-related inquiries from health center staff to expand knowledge of issues and resolutions methods.


• Process incoming correspondence for the assigned health centers, including payer notifications, returned claims and take appropriate action to resolve and rebill to the corrected claim.


• May need to report onsite when required and perform additional duties and special projects, if closer to the administrative office. 


• Must meet department’s productivity and claim submission benchmarks and billing Key Performance Indicators (KPIs) and benchmarks.


• Adhere to departmental policies, procedures, billing guidelines, productivity expectations, and established timelines.


• Maintain confidentiality of patient and organizational information in accordance with HIPAA regulations.


• For remote work arrangements, maintain a secure, organized, and HIPAA-compliant work environment that supports productivity and protects confidential information.


• Perform other duties and special projects as assigned

Non- Essential Duties:

• 
  

  Serve as backup for other employees for breaks and absences as needed



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  Perform other duties as assigned

Qualifications

• 
  

  High School Diploma required



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  Knowledge of professional claims billing or one to two years of experience in medical billing.



• Ability to manage multiple tasks/projects simultaneously and adapt to frequent priority changes


• Good writing, editing and communication skills with attention to detail and accuracy


• Knowledge of Medi-Cal, State Programs & Commercial Insurance (HMO, PPO, EPO, etc) preferred


• Basic proficiency in Microsoft Word and Excel


• Must adhere to all HIPPA guidelines and regulations and maintain patient and organization confidentiality.


• Must follow affiliate policies and procedures

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