Job Detail

Hope Comprehensive Center for Development is seeking an experienced Clinical Billing Specialist to help orchestrate the daily billing operations of a busy pediatric speech, ABA and occupational therapy clinic. You will be responsible for managing claims by preparing, processing and tracking billing and collections for large commercial and state funded insurance companies for their assigned clients. The main objective of this position is to collaborate with other team members to achieve a 95% or higher approval rate for all insurance claims. Serving as a point of contact for patients, this position is critical in creating a great customer service experience for our patients and staff alike. In this role you will work closely with your fellow front-office personnel, physician groups and patient payer sources to ensure proper patient authorization; as well as our team of therapists in scheduling patients to ensure maximum company revenue. Navigating through denied claims with attention to detail and clear, positive communication is key. Working closely with the company Directors and within a growing team, you will play an important role in establishing and implementing standard operating procedures. Knowledge and experience in therapeutic medical billing and the ICD-10 system is critical. With access to sensitive patient information, strong adherence to HIPAA laws is mandatory. With a significant portion of our patient base having Spanish as their primary language, strong command of both written and spoken English and Spanish is preferred for this position.

While this position doesn't require a fancy degree, we do require demonstrated success and experience in working in a similar role. Astound us with your boundless energy and enthusiasm.

The position offers medical/dental/vision insurance, SIMPLE IRA retirement plan, paid holidays, and personal leave and sick leave.

About Us

We are expanding our presence throughout Riverside and San Diego Counties and provide an opportunity to work in a creative and entrepreneurial environment. We work with talented people and trust them to get the job done. We don’t micro-manage. We believe in learning from others and continuous improvement along the journey of sustainable growth and being a key player in Southern California in the fields of speech, ABA and occupational therapy. Come join our team and spread HOPE to children, parents, the elderly and their caregivers!'
Hours per week:

• 40

Overtime often available:

• With permission

Job Summary:

The Clinical Billing Specialist manages claims by preparing, processing and tracking billing and collections for Medicaid and other insurance companies for their assigned clients. The main objective of this position is to collaborate with other team members to achieve a 95% or higher approval rate for all insurance claims.

Key Responsibilities:

• Prepares service documentation for billing to ensure all documentation is prepared, completed, and submitted correctly and according to time lines.
• Processes billing for all assigned ABA and other therapy services in accordance with agency timelines and within the insurers requirements.
• Processes payments from insurance providers, clients, and/or others submitting payment for services to the organizations including posting of charges, payments, and reviewing of remittance and EOB documentation, etc., as assigned.
• Works closely with the claims department of payers to research claim denials and ensure outstanding claims are quickly and accurately resolved so payment is received.
• Reviews outstanding payments for billed services and researches if and how billing should be resubmitted.
• Prepares reports and documentation for finance department related to services provided, billing submitted, accounts receivables, write offs/uncollectible, etc.
• Works toward a goal to ensure outstanding claims are not aged past 60 days.
• Works collaboratively with other staff involved in billing processes.
• Maintains electronic health records and billing systems with current payer information and insurance coverage for individuals.
• Constantly evolves with billing processes to ensure ABC is processing and submitting claims in the most efficient way possible.
• Cross-train other members of the finance department as needed.
• Verifies insurance coverage and eligibility
• Provides administrative support to Clinicians as needed.
• Performs other duties as assigned.

Physical Requirements:

• Must be able to type and write and sit at a computer for a long period of time.

Minimum Qualifications (Education, Experience, Knowledge, Skills):

• High School Diploma/GED required.
• Minimum of 2 years of experience working with insurance billing and seeking prior authorization for healthcare services. Behavioral health billing and authorization experience strongly preferred.
• Utilize electronic health records and both manual and electronic billing systems.
• Ability to work both independently and as part of a team.
• Strong customer service and interpersonal skills.
• Excellent written and verbal communication skills.
• Ability to prioritize workload and competing priorities to meet the needs of the organization.
• Knowledge of computer systems and applications- Word, Excel, Power Point, Outlook, practice management systems, electronic health records.
• Excellent problem solving skills.
• Excellent decision making skills.
• Strong teamwork and leadership skills.
• Strong administrative and organizational skills.
• Ability to maintain a realistic balance among multiple priorities.
• Pass a criminal background check.

Job Types: Full-time, Part-time

Pay: $18.00 - $21.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• ICD-10: 2 years (Preferred)

Language:

• Spanish (Preferred)

Work Location: One location