Job Detail

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

• Review claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission.
• Re-prints and/or re-batches paper and electronic claims for timely re-submission of denied claim.
• Knowledge of industry standard and Medi-Cal denials reasons/codes.
• Handle information about patient treatment, diagnosis, and related procedures to ensure clean claim submissions.
• Know several different coding systems, including Level 1 HCPCS and Level 2 HCPCS.
• Compile billing, and payer documentation to create training documents.
• Use computers to read and organize charts.
• Ensure healthcare facilities are reimbursed for all procedures.
• Collect, post, and manage patient account payments.
• Submit claims to insurance within corporate charge posting lag.
• Process payments from insurance companies.
• Follow up on claim submissions to determine batch acceptance, rejection, or denial.
• Researches, correct, resolve, resubmit and appeal denied claims/services.
• Corresponds with insurance companies to resolve the issue; submits appeals per payer requirements.
• Maintains collections rate for assigned payers at or above 70% of allowed charges.
• Communicate with RCM leadership about payer updates, changes, and requirements.
• Review delinquent accounts and call responsible party(ies) for collection purposes.
• Sort and file paperwork from health plans, patient charts, and payment correspondence.
• Investigate insurance fraud and report if found.
• Maintain strict confidentiality.
• Other duties as assigned by Director RCM.

• Strong commitment to quality healthcare and excellent customer service.
• Strong verbal and written communication skills are essential.
• Ability to demonstrate mature judgment, initiative and critical thinking.
• Strong follow-up skills and time management with internal and customer stakeholders
• Knowledge of MS Excel.
• 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.
• Experience with electronic practice management system and electronic health record system (minimum 1 year).

• Three years of experience as a medical biller/claims follow-up specialist or collections specialist in an outpatient medical setting (non-hospital) in primary care (required), family planning, ob-gyn, and related surgeries.
• Medical terminology.
• Associate’s or Bachelor’s Degree preferred or equivalent experience in related field.
• Computer database management (electronic practice management system). EclinicalWorks/NextGen experience preferred.
• 3+ years experience in Billing and coding procedures.
• 3+ years experience with insurance billing and reimbursement procedures.
• 2+ years’ experience with HIPAA 5010 transaction standards.
• 2+ years claims follow-up/appeals and health plan Accounts Receivable management for specific payers.

Planned Parenthood/Orange and San Bernardino Counties is an equal opportunity employer. Applicants will receive consideration for employment without regard to race, color, ancestry, national origin, religion, creed, equal pay, age, disability, sex, gender, sexual orientation, gender identity, gender expression, medical condition, genetic information, marital status, military, veteran status or any other federal or state protected class. We are committed to building and maintaining an inclusive workplace that values diversity, equity, and inclusion.