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
• Perform other duties as assigned

Qualifications

• High School Diploma required
• 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