Medical Billing Specialist - Anaheim Admin

Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for a Medical Billing Specialist in Anahiem, CA.

Medical Billing Specialist at PPOSBC is responsible for ensuring the timely submission of medical claims to insurance companies, including physician offices, payers, medical groups or other healthcare facilities and certifies clean claim, charge posting and billing to obtain accurate reimbursement for healthcare claims. Medical Billing Specialist must possess solid knowledge of the billing process from start to finish including in depth knowledge of billing best practices. Must serve as a subject matter expert and liaison between Management, Billing team and other stakeholders. Must have knowledge in Family planning and Primary care billing, as well as possess the ability to identify billing errors that may result in corrections and when necessary, communicate the directives to necessary parties. Responsible for entering, and correcting medical claims insurance information into a computer system and generating invoices to be sent to the health plans. Responsible for compiling and updating revenue cycle management on payer billing and regulatory updates. Medical Billing Specialist’s work is focused on all high-volume facilities and all payers, including State of California’s health programs.

At PPOSBC, we understand the importance of a well-rounded benefits program and are dedicated to providing you with unique benefits that meet the needs of you and your family. We are proud to offer a range of plans that help protect you in the case of illness or injury including:

• A competitive benefits package including medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability. 
• Benefits coverage starts after one full month of employment!
• Generous vacation, sick, and holiday benefits!
• Generous 401(k) matching contributions and more!
• To view our detailed benefits guide, please visit our career site at www.pposbccareers.org

Responsibilities

Essential Functions: Essential functions encompass the required tasks, duties and responsibilities performed as part of the job and the reason the job exists.

• Serves as a liaison between management and the billing team.
• Reviews appropriate documents for billing accuracy, corrects order code (appointment type), Billing Policy for instructions, financial class, demographics, medical records, proper physician information for billing requirements, place/date of service, and notes to determine accurate creation of the patient’s encounter.
• Reviews and monitors day to day productivity to ensure that billing deadlines are met.
• Maintains in-depth knowledge of payer regulations and reimbursement methodologies to assure accurate reimbursement.
• Keeps abreast of changes in authorization process, insurance policies, billing requirements, rejection or denial codes as they pertain to claim processing and coding.
• Maintains a billing accuracy percentage of 95% to ensure clean claims submission.
• Compiles billing and payer documentation to assist management in training tools.
• Communicates with RCM leadership about payer updates, changes, and requirements.
• Reviews claims to ensure that billing data adheres to governmental and state requirements for all Family Planning billing including surgery claims.
• Ensures that all required signatures and authorizations are in place prior to submission.
• Handles information about patient treatment, diagnosis, and related procedures to ensure clean claim submissions.
• Reviews patient bills for accuracy and completeness, and obtains any missing information.
• Prepares, reviews, and transmits claims using billing software, including electronic and paper claims processing.
• Maintains knowledge levels of payer changes as they occur.
• Validates eligibility and benefits verification to ensure that claims are billing to appropriate payer.
• Uses computers to read and organize charts.
• Ensures healthcare facilities are reimbursed for all procedures.
• Posts and manages patient account payments.
• Submits claims to insurance within corporate charge posting lag.
• Follows up on claim submissions to determine batch acceptance, rejection, or denial.
• Researches, corrects, resolves, resubmits rejected or errored claims/services.
• Corresponds with insurance companies to resolve issues.
• Communicates with RCM leadership about payer updates, changes, and requirements.
• Reviews delinquent accounts and calls responsible party(ies) for collection purposes.
• Investigates insurance fraud and reports if found.
• Maintains strict confidentiality.
• Regularly attends monthly staff meetings and continued educational sessions as requested.

Non-Essential Functions:

• Other duties as assigned.

PHYSICAL REQUIREMENTS:

The physical requirements of this position are identified below. Reasonable accommodations may be made for individuals with disabilities to perform the essential functions of this position.

CORE COMPETENCIES – WE CARE:

• Welcoming: Anticipates customer requirements and gives high priority to customer satisfaction and service.  Handles problems quickly and efficiently.  Maintains a pleasant, positive and professional approach. Embraces opportunities to help team members, stakeholders, and other departments.
• Equitable:Creating equitable access and opportunity for all through education, practicing inclusive behavior, elevating others’ voices, creating spaces for honest conversation, and listening without judgment.  Values and uplifts our collective diversity within in our agency.
• Confidential: Respects the information shared by our patients, employees, and vendors and maintains appropriate confidentiality.  Follows all policies and laws that protect private & privileged information.
• Accessible: Is available and approachable to others, open-minded, fair and non-defensive.  Appreciates constructive feedback and is a team player.  Demonstrates good listening skills.
• Respectful:  Values diversity and treats everyone with dignity and courtesy.  Dependable and courteous of other people’s time and commitments.
• Empathetic: Demonstrates interest and understanding in other people’s feelings, attitudes and reasoning.  Maintains an open and non-judgmental demeanor that is patient, flexible, and understanding.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education:

• High school diploma or Associate’s preferred or equivalent experience in related field.

Minimum Work Experience:

• A minimum of 3-5 years of experience as a medical biller in an outpatient medical setting (non-hospital) family planning, ob-gyn, and related surgeries required.
• A minimum of 3-5 years of experience with electronic practice management system and electronic health record system.
• Advanced knowledge of medical terminology and common industry abbreviations, anatomy and physiology, pharmacology, and pathophysiology.
• Advanced knowledge of coding guidelines, policies and procedures.
• High school diploma or Associate’s preferred or equivalent experience in related field.
• Computer database management (electronic practice management system). EClinicalWorks/NextGen experience preferred.
• A minimum of 3-5 years of in medical insurance billing and coding procedures.
• A minimum of 3-5 years of with insurance billing and reimbursement procedures.
• A minimum of 3-5 years of with HIPAA 5010 transaction standards. 

Other Requirements:

• Strong written, verbal and interpersonal communication skills.
• Strong analytical skills.
• Strong organizational / prioritization skills.
• Strong commitment to quality healthcare and excellent customer service.
• Ability to apply coding guidelines to billing guidelines to validate appropriate billing.
• Ability to demonstrate mature judgment, initiative and critical thinking.
• Ability to read and interpret insurance eligibility to determine payer responsibility.
• Demonstrate a strong knowledge of the payer contracts and DOFR to ensure that claims are sent to the correct payer.
• Maintain the productivity level as established by Management.
• Strong knowledge of Family Planning, Medi-Cal, Commercial, Medi-Cal Managed Care and Primary Care billing.
• Strong follow-up skills and time management.
• Familiarity with medical terminology.
• Ability to maintain confidentiality.
• Accuracy and attention to detail is essential.
• Proficient in MS Office: Excel, MS Word, Outlook.
• Professional demeanor at all times.
• Availability to work flexible hours including weekend.
• Ability to multi-task and work courteously and respectfully with fellow employees, clients and patients.

Agency Standard Requirements:

• Strong commitment to quality healthcare and excellent customer service is required.
• Must thrive in a fast paced, rigorous environment with changing priorities.
• Ability to meet deadlines and work under pressure.
• Must demonstrate high level computer skills including; Microsoft Word, Excel and Outlook. Electronic medical records experience may also be required.
• Abortion patients are cared for at each of our health centers and in part through the administrative, support, and other non-clinical services provided at all PPOSBC locations and by all PPOSBC employees, and supporting these critical services is an essential job duty and fundamental responsibility of all employees.