Biller - Administration

Northeast Community Clinic•Alhambra, CA

59d•Hybrid

About The Position

The Medical Biller stationed at administration office, will provide support services needed to complete the claim adjudication process, by reconciliation.

Requirements

Microsoft Office/Word/Excel/Outlook
Excellent Communication Skills
Excellent Customer Service Skills
Ability to work as a team player and work independently
Reliable transportation
Must be able to travel from facility to facility
High school or GED equivalent
Certificate in medical billing
Knowledge of HCPCS, CPT and ICD9
Medical terminology
Commitment to goals and philosophy of Northeast Community Clinic
Valid State Identification

Nice To Haves

Knowledge of Medi/Cal reimbursement guidelines preferred
Bi-lingual Spanish/English (preferred)

Responsibilities

Submit/generate claim(s) file(s) to health insurance plans, both paper and electronic on a weekly basis and ensure their receipt (e.g. PM160, CMS1500, email ticket, volser etc…)
Submit/generate encounter(s) to the appropriate IPA/ health plans, both paper and electronic on a weekly basis and ensure their receipt (e.g. PM160, CMS1500, email ticket, volser etc…)
Post Remittance Advice and Explanation of Benefits, both paper and electronic on a weekly basis.
Organize superbills (e.g. file, scan, label, etc…)
Interface with billing/clinic staff and providers to obtain any required information needed to enter and bill/rebill a claim (e.g. correct payor on superbill, authorizations, diagnosis, etc…)
Generate/re-generate superbills (e.g. hospital round etc…)
Generate/create various reports/invoice (e.g. hospital round, MAOF, “Daily Superbill Report”, etc…)
Adjudicate all claim types.
Provide back-up support to clinical biller, ensuring claim deadlines are met by creating claims entering all superbills generated on a daily basis from clinic site(s).
QA superbills for accurate data entry (e.g. eligibility, payer, diagnosis, etc…)
Ensure completeness of claims for proper payment (e.g. PM160, CMS1500, attachments etc…)
Provide superbills or any attachment(s) requested (e.g. rebilling, HEDIS, superbills for audit, etc…)
Contact insurance vendors (e.g. eligibility, denials, claims submission, etc…)
Assist in billing projects.
Attend trainings, meeting, workshops and webinars as needed.
Provider back-up support to receptionist is out.
Will perform other related duties as assigned by the Billing Supervisor, Billing Manager, Controller, Finance Director or Executive Director.