Billing Specialist I (.20 FTE)

La Clinica de La Raza•Oakland, CA

About The Position

La Clínica de La Raza is a community-based health center providing culturally appropriate, high-quality, accessible health care to diverse communities in the San Francisco Bay Area. The Billing Specialist I is responsible for maintaining a major portion of a complex billing operation and ensuring that claims submitted to payors contain accurate information. The role requires understanding individual payors, working claim denials, and following up to help ensure claims are paid. The position is listed as .20 FTE and involves a considerable amount of computer work. The Billing Specialist supports claim submission and denial management, audits complex patient claims for accuracy and compliance, and identifies ways to improve claim data and reduce denials and accounts receivable. The role also supports patient and payor statements and collections by posting and balancing payments, sending statements, arranging payments for delinquent accounts, responding to billing questions, resolving billing issues, and protecting confidential collection information.

Requirements

High school diploma or equivalent.
Three or more years of full-time experience performing medical billing or medical accounts receivable functions.
Knowledge of health care third-party reimbursement programs, such as Medicare, Medi-Cal, or private insurance.
Knowledge of billing, accounts receivable, and collection methods and practices.
Knowledge of modern office methods and equipment.
Ability to prepare financial reports and maintain ledgers and journals.
Ability to interpret billing policies and procedures for various programs.
Ability to independently carry out varied responsible billing assignments.
Ability to solve problems and resolve conflicts.
Ability to work across cultures and demonstrate support for diversity, equity, and inclusion.
Excellent communication skills and ability to work in a team environment.
Excellent customer service skills.

Responsibilities

Maintain billing work operations for payers by following policies and procedures and identifying compliance issues.
Maintain quality in billing and collection procedures by following established standards.
Perform general clerical duties as required.
Work with billers to ensure claim information is correct before submission.
Audit complex patient claims for arithmetical accuracy, legibility, and compliance with program billing requirements.
Understand complex reimbursement arrangements and follow up with payors to help ensure claims are paid.
Identify ways to improve claim submission data and reduce claim denials.
Reduce accounts receivable by improving claim accuracy and reducing denials.
Post, adjust, and balance payments and send regular patient statements to secure outstanding balances.
Collect delinquent accounts by establishing payment arrangements with patients or payors, monitoring payments, and following up when payments lapse.
Respond to patient and payor questions about claims and resolve billing issues.
Keep collection information confidential.