Job Detail

SUMMARY:

Applicant must possess a High School Diploma or equivalent. Must have 3 years experience in collections, posting, and insurance billing; be familiar with all forms of billing, i.e., Medicare, Medi-Cal, both primary and rural, private insurance and CHDP. Previous accounting or insurance posting experience, and basic knowledge of various spreadsheet applications, preferred. Must possess customer service skills. Excellent grammar, spelling, verbal, and written communication skills are required. This position is responsible for timely claims payment posting and ensuring that RSBCIHI receives maximum revenue by monitoring client medical claims for non-payment, delayed payments and other irregularities. The position is also responsible for supporting the monthly close and reconciliation process. Must be able to work with the Indian Community, and be sensitive to the Indian Culture and its needs.

MAJOR DUTIES AND RESPONSIBILITIES:

• Prepare, post, verify and record payments and transactions related to accounts receivable.
• Copies, files, and retrieves materials for accounts receivable as needed.
• Determine and initiate corrective action required to bring accounts into agreement.
• Prove the accuracy of adjusted accounts
• Examines accounts or resolves reconciliation which requires an analysis of adjustments and corrective entries in the patient account system
• Trace transactions entered and prepare and/or provide supporting documents reflecting the source of discrepancies.
• All accounts are reviewed and researched within 30 days and documented in NextGen message field and communicate with the Revenue Cycle Lead and Director of HIM-Billing & Coding any areas of concerns identified.
• Electronically auto-posts payments and adjustments to patient accounts in a timely manner, to support accounting reconciliation and the monthly close process.
• Validates that all electronic payments have been appropriately credited.
• Posts all manual payments and adjustments to patient accounts in a timely and accurate manner.
• Consistently evaluates the accuracy of third party payment, denials and adjustments.
• Researches, reviews, and resolves any inconsistent payments (under or over the expected amount).
• Follows up on all outstanding accounts over 90 days, post submission of the claim.
• Creates electronic notes to identify denials and zero pays for rework by respective functions.
• Prepares A/R reports for billing & coding supervisor.
• Once it is determined whether to initiate a refund or allow recoupments/offsets; initiates the process in the case where payment needs to be refunded to the insurer.
• Identifies patterns or potential issues and intervenes to prevent adverse impact.
• Creates, reviews, and corrects claims to ensure accuracy, proper format (paper or electronic claim), and compliance with third party payer requirements prior to claim completion and submission.
• Follows-up with coder/biller when information is missing or inaccurate.
• Confirms insurer sequencing order and coordination of benefits.
• Ensure that associated documentation is sent along with claims when needed and/or EOB from primary denial.
• Reviews insurance returns mail (containing claims or debt letters), determines reasons for return, and takes necessary steps for resolution.
• Reviews inquiries from insurance company to determine steps for appropriate resolution.
• Collaborates with Revenue cycle lead to reconcile accounts receivable on a periodic (at least bimonthly) basis and reconciling revenue accounts each month.
• Generates the Aging summary and detailed report for all third party payers and completes follow-up for unpaid bills. This report should include any accounts that exceed 180 days from date of service, to determine proper disposition.
• Other duties as assigned

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MINIMUM QUALIFICATIONS:

Education:

High school graduate or equivalent.

Experience:

Previous accounting or insurance posting experience

Familiarity and understanding of health insurance coverage

Exceptional customer service

Proficiency with Medical Billing systems, preferably NextGen Proficiency withMicrosoft Excel

Must have at least three years’ experience in patient insurance billing and be familiar with all forms of billing, i.e., Medicare, Medi-Cal, both primary and rural, private insurance and CHDP.

Knowledge of:

Familiarity of various insurance companies and the requirements of each. The incumbent must also be knowledgeable of the unique differences between rural and primary billing as it relates to Medi-Cal billing. Must also be familiar with Cash Flow concepts and cash/receipt procedures.

Skill:

Data entry skills are preferred.

Excellent organizational skills and attention to detail.

Must have excellent verbal and written communication skills.

Must demonstrate ability to organize work in a logical manner.

Computer skills must be proficient in data entry.

Basic knowledge of various spread sheet applications is preferred.

Computer skills must be proficient with various spreadsheet application.

Ability to:

Ability to work independently and in a fast-paced environment. Ability to anticipate work needs and interact professionally with insurance payers. Maintain strict confidentiality procedures.

Must be able to work with the Indian Community, and be Sensitive to the Indian culture and its needs.

Physical Demands:

The work is mostly sedentary. However, the employee must be able to carry items weighing up to 25 pounds. The work is normally performed in an office setting.

Extensive travel may be required.

Work Location:

San Manuel Indian Health Clinic (11980 Mt. Vernon Ave. Grand Terrance Ca, 92313)

Job Type: Full-time

Pay: $21.00 - $23.00 per hour

Expected hours: No less than 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Vision insurance

Physical Setting:

• Office

Schedule:

• 8 hour shift
• Monday to Friday

Ability to Relocate:

• Grand Terrace, CA 92313: Relocate before starting work (Required)

Work Location: In person