Billing Coordinator I

Planned Parenthood Mar Monte Careers•San Jose, CA

5d•Hybrid

About The Position

The Billing Coordinator I is responsible for reviewing claims for accuracy, ensuring compliance with payer guidelines, and processing charges for submission. This role involves monitoring and resolving claim rejections, responding to billing inquiries, and processing incoming correspondence. The position requires adherence to departmental policies, productivity benchmarks, and HIPAA regulations. For remote work, a secure and compliant work environment is necessary. Additional duties and special projects may be assigned.

Requirements

High School Diploma required
Knowledge of professional claims billing or one to two years of experience in medical billing.
Ability to manage multiple tasks/projects simultaneously and adapt to frequent priority changes
Good writing, editing and communication skills with attention to detail and accuracy
Basic proficiency in Microsoft Word and Excel
Must adhere to all HIPPA guidelines and regulations and maintain patient and organization confidentiality.
Must follow affiliate policies and procedures

Nice To Haves

Knowledge of Medi-Cal, State Programs & Commercial Insurance (HMO, PPO, EPO, etc) preferred

Responsibilities

Review governmental and non-governmental payer claims for accuracy and ensure billing charges comply with payer-specific guidelines.
Work daily unbilled charge reports to identify discrepancies, process charges, and submit claims according to established processes and workaids.
Monitor and resolve claim production red edit reports daily, to clear edit, coordinate with health center staff for corrections and ensure timely claim submission.
Review and resolve rejected claims queues in the clearinghouse to transmit claims per workaids and expectation set by department.
Respond to billing-related inquiries from health center staff to expand knowledge of issues and resolutions methods.
Process incoming correspondence for the assigned health centers, including payer notifications, returned claims and take appropriate action to resolve and rebill to the corrected claim.
May need to report onsite when required and perform additional duties and special projects, if closer to the administrative office.
Meet department’s productivity and claim submission benchmarks and billing Key Performance Indicators (KPIs) and benchmarks.
Adhere to departmental policies, procedures, billing guidelines, productivity expectations, and established timelines.
Maintain confidentiality of patient and organizational information in accordance with HIPAA regulations.
For remote work arrangements, maintain a secure, organized, and HIPAA-compliant work environment that supports productivity and protects confidential information.
Perform other duties and special projects as assigned.
Serve as backup for other employees for breaks and absences as needed.
Perform other duties as assigned.