Biller - Administration

Position Summary

The Medical Biller stationed at administration office, will provide support services needed to complete the claim adjudication

process, by reconciliation.

Schedule:

Full-time (Non-Exempt)

Flexible, may require some evening and weekends

Primary Duties and Responsibilities

Submit/generate claim(s) file(s) to health insurance plans, both paper and electronic on a weekly basis and ensure

their receipt (e.g. PM160, CMS1500, email ticket, volser etc…).

Submit/generate encounter(s) to the appropriate IPA/ health plans, both paper and electronic on a weekly basis and

ensure their receipt (e.g. PM160, CMS1500, email ticket, volser etc…).

Post Remittance Advice and Explanation of Benefits, both paper and electronic on a weekly basis.

Organize superbills (e.g. file, scan, label, etc…).

Interface with billing/clinic staff and providers to obtain any required information needed to enter and bill/rebill a

claim (e.g. correct payor on superbill, authorizations, diagnosis, etc…).

Generate/re-generate superbills (e.g. hospital round etc…).

Generate/create various reports/invoice (e.g. hospital round, MAOF, "Daily Superbill Report", etc…).

Adjudicate all claim types.

Secondary Duties

Provide back-up support to clinical biller, ensuring claim deadlines are met by creating claims entering all superbills

generated on a daily basis from clinic site(s).

QA superbills for accurate data entry (e.g. eligibility, payer, diagnosis, etc…).

Ensure completeness of claims for proper payment (e.g. PM160, CMS1500, attachments etc…).

Provide superbills or any attachment(s) requested (e.g. rebilling, HEDIS, superbills for audit, etc…).

Contact insurance vendors (e.g. eligibility, denials, claims submission, etc…).

Assist in billing projects.

Attend trainings, meeting, workshops and webinars as needed.

Provider back-up support to receptionist is out.

Will perform other related duties as assigned by the Billing Supervisor, Billing Manager, Controller, Finance Director

or Executive Director.

Minimum Requirements

Microsoft Office/Word/Excel/Outlook

Excellent Communication Skills

Excellent Customer Service Skills

Knowledge of Medi/Cal reimbursement guidelines preferred

Bi-lingual Spanish/English (preferred)

Ability to work as a team player and work independently

Reliable transportation

Must be able to travel from facility to facility

This position requires 10 % travel outside the local area.

Required Education/Experience and/or Licensure/Certification

High school or GED equivalent

Certificate in medical billing

Knowledge of HCPCS, CPT and ICD9

Medical terminology

Commitment to goals and philosophy of Northeast Community Clinic

Valid State Identification

Physical Requirements and Working Conditions

OSHA Category 3 - Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to

blood, body fluids, or tissues are not a condition of employment.

The work is majority of the time sedentary in nature.

The employee is regularly required to communicate, frequently required to use repetitive motions, move, remain

stationary, regularly push, pull and lift up to 20 pounds and occasionally push, pull and lift up to 40 pounds.

Must possess mobility to work in a standard office/clinic setting (in some cases both settings) and to use standard

office/clinic equipment, including a computer, stamina to maintain attention to detail despite interruptions, read

printed materials and use a computer, and communicate in person and over the telephone.