Insurance Biller II - Escondido, California, , United States

ABOUT US: · Community health is about more than just vaccines and checkups. It's about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We're with you every step of the way, with ...

Job description

ABOUT US:

Community health is about more than just vaccines and checkups. It's about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We're with you every step of the way, with the care you need for each of life's chapters. At Neighborhood, we are Better Together.

As a private, non-profit 501(C) (3) community health organization, we serve over 500,000 medical, dental, and behavioral health visits from more than 100,000 people annually. We do this in pursuit of our mission to improve the health and happiness of the communities we serve by providing quality care to all, regardless of situation or circumstance.

We have been doing this since 1969 and it is our employees that make this mission a reality. Regardless of the role, our team focuses on being compassionate, having integrity, being professional, always collaborating, and consistently going above and beyond. If that sounds like an organization you want to be a part of, we would love to have you.

ROLE OVERVIEW and PURPOSE:

The Insurance Biller II works to support the mission and vision of Neighborhood Healthcare (NHC) by processing and supporting the medical billing process for patients and other funding sources. This role will validate correct coding processes to ensure compliance with NHC, contracts, funding programs, and agencies. 

**This is a hybrid position with a typical schedule of 2 days onsite and 3 days remote. This role will also be expected to come onsite for department meetings every 2 months.**

RESPONSIBILITIES:

• Reviews progress notes to obtain payer measures and requirements information for proper submission compliance
• Reviews and obtains required information for missing and incomplete billings, such as missing DX, procedure codes, payer specific needs, eligibility screening, and coverage verification
• Creates and submits claims for clean billable charges and statements in compliance of correct coding initiatives and billing industry requirements
• Processes and monitors system claim status categories to ensure all transactions are captured for month end close
• Registers patients in the payment portal, as needed
• Reviews, processes, and obtains patient eligibility information to ensure accuracy and completion, including acquisition of authorization numbers, as needed
• Applies discounts to billing statements for patients eligible for the Sliding Fee Discount Program (SFDP), as needed
• Posts patient and insurance payments to account balance adjustments and write offs, as assigned
• Monitors and reports insurance payment denials, including coding issues and benefit changes
• Reviews and processes aging claims and denials, including claim tracers, corrected claim submissions, appeals, and consistent revenue flow
• Reviews and processes refunds and insurance recoupment requests
• Submits patient statements on cash accounts, as needed
• Processes monthly collection accounts for collection agencies, as needed
• Supports site related phone lines and voicemails; returns calls, as needed
• Discusses escalated billing inquiries with patients, third party payers, and/or sites to resolve account questions and/or problems
• Negotiates payment plans with patients, as needed
• Provides excellent customer service to patients and escalate issues to a supervisor, if needed
• Responds to site, insurance, and patient correspondences related to billing in a timely manner
• Attends billing training and team meetings

EDUCATION/EXPERIENCE:

• High school diploma/GED required
• Two years of dedicated medical billing experience in a healthcare environment required
• Medical Billing or Coding Certification from an accredited school preferred
• Experience working in a specialty and/or FQHC community clinic is preferred

ADDITIONAL QUALIFICATIONS (Knowledge, Skills and Abilities):

• Excellent verbal and written communication skills, including superior composition, typing and proofreading skills
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Knowledgeable about and experience with insurance eligibility processes and coverage guidelines for multiple carriers
• Knowledgeable about and experience with billing compliance standards
• Knowledgeable on uses of CPT, HCPCS, and ICD codes
• Knowledgeable with insurance payers, funding sources, and managed care plans.
• Ability to successfully manage multiple tasks simultaneously
• Excellent planning and organizational ability
• Ability to work as part of a team as well as independently
• Ability to work with highly confidential information in a professional and ethical manner

Pay Range: $ $38.09 per hour, depending on experience

Compensation Disclosure: The posted salary range reflects the designated pay grade for this position. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to: the candidate's overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs. As a result, placement within the range is not guaranteed, and the full pay grade range may not be utilized.