Medical Biller/collector - Los Angeles, United States - St Johns Community Health
Description
The Medical Collector II is a full-time position responsible for managing denials and collecting outstanding account receivables securing payment of denied claims for Medical, Dental, Optometry, Behavioral Health, OB-GYN, and Podiatry, claims.
This is a challenging and rewarding position that requires strong communication skills, attention to detail, and the ability to work in a fast-paced environment.
This position reports to the Billing Manager, in some cases, the focus may be on either coding or billing, but must be cross trained in both.
BENEFITS
- Free Medical, Dental & Vision
- 13 Paid Holidays + PTO
- 403 (B) retirement match
- Life Insurance, EAP
- Tuition Reimbursement
- Flexible Spending Account
- Continued workforce development & training
- Succession plans & growth within
QUALIFICATIONS
Education and Experience
- Three (3) years of experience with revenue cycle operations management. With excellent presentation and writing skills. Advanced skills in analysis and MS Office suite. eClinical Works experience is preferred.
- High school diploma or GED required. Billing Certification required.
- Demonstrated knowledge of all Insurance companies, HMO's, PPO's Government and State programs Medi-Cal and Medicare, and thirdparty payers.
- Experience with managing revenue cycle processes including Medicaid and Medi-Cal eligibility, health information management and billing, and charge capture processes.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Performs a combination, but not necessarily all, of the following duties:
- The billing department encompasses medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
- Works through patient insurance documentation, billing and collections, and data processing to ensure accurate billing and efficient account collection.
- Analyzes billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues.
- Follows up on claims using various systems, such as eClinical Works, Claim Remedi clearinghouse, Medicare DDE, Online payer sites, etc.
- Maintains contacts with other departments to obtain and analyze patient information to document and process billings.
- Successfully scrubs and quality controls claims prior to submission.
- Works the A/R, works rejected claims, and provides necessary followup to ensure successful claim processing.
- Provide quality control checks of denied claims, the ability to process tracers, process contractual adjustments and allocation of funds; initiate appeals.
- Generate denials reports as needed.
- Trains new Collector staff
- Generate month end close patient financial communication letters and statements.
- Reviews month end close Good Faith Estimates patient communication
- Provides Billing Records to 3rd parties and reviews to maintain HIPAA.
- Evaluate remittance to ensure accuracy and analysis of CAS and denial codes.
- Maintains strong attention to detail and ability to multitask.
- Maintains extremely high standards of professional conduct.
- Establishes and maintains effective working relationships with the office staff and Doctors.
- Adheres to policies regarding safety, confidentiality, and HIPAA guidelines.
- Ensures that the activities of the collection operations are conducted in a manner that is consistent with overall department protocol and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.
- Serves as a practice expert and goto person for denials questions and advice.
- Performs other job duties as assigned.
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