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
Numbers & Facts
Location
San Jose, California
Website
https://www.ppmmcareers.org
Skills
Benchmarkingunmatched
Billingunmatched
Communication Skillsunmatched
Detail Orientedunmatched
Editingunmatched
HIPAA (Health Insurance Portability and Accountability Act)unmatched
Health Maintenance Organization (HMO)unmatched
Information/Data Security (InfoSec)unmatched
Insuranceunmatched
Mail Processingunmatched
Medi-Calunmatched
Medical Billingunmatched
Medical Recordsunmatched
Microsoft Excelunmatched
Microsoft Wordunmatched
Multitaskingunmatched
Organizational Skillsunmatched
Patient Confidentialityunmatched
Performance Metricsunmatched
Preferred Provider Organization (PPO)unmatched
Problem Solving Skillsunmatched
Process Developmentunmatched
Regulationsunmatched
Reporting Skillsunmatched
Sales Closing Skillsunmatched
Time Managementunmatched
Work From Homeunmatched
Writing Skillsunmatched
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