Call Processing Reimbursement Specialist I (English/Spanish Bilingual Required)

San Ysidro Health•San Diego, CA

12h•$25 - $31

About The Position

The Call Processing Reimbursement Specialist I is responsible for the complete revenue cycle, including billing medical, dental, and/or hospital claims and working directly with members by phone. The role follows up on insurance balances to ensure reimbursement is accurate and timely, manages self-pay collections after insurance, and answers billing-related questions. The specialist provides telephone customer service to patients and internal customers, handles inquiries and grievances according to established protocols, and documents communications in the online practice management system. The position prepares and submits claims, follows up and appeals unpaid claims, coordinates secondary payer billing, and supports accurate account adjustments and reimbursement. The role may also support special projects and internal and external audits.

Requirements

At least 1 year of experience in a medical billing department.
Knowledge of CPT, HCPCs, and ICD-10 coding and medical terminology.
High school diploma or GED equivalent.
Bilingual English/Spanish.
Good oral and written communication skills.
Positive customer service skills.
Ability to communicate effectively in English verbally and in writing.
Ability to work independently.
Experience with Microsoft Office software.
Math ability to calculate and accurately analyze accounts.
Meet pre-employment requirements, including I-9, physical, positive background and reference check results, completed application, new-hire orientation, and pre-employment PPDs.
Comply with mandated vaccinations and boosters as a term and condition of employment.

Responsibilities

Demonstrate knowledge of San Ysidro Health services and programs to answer questions and direct calls appropriately.
Review, collect, and update patient demographic information and take appropriate action when changes are identified.
Provide excellent customer service by greeting, listening to, assisting, directing, and closing each call.
Recognize and handle unique medical issues, urgent services, and patient grievances according to established protocols; resolve issues or escalate them to a supervisor as appropriate.
Log in and be ready to receive or make calls according to the schedule, and use break codes as defined by the call management system.
Provide quality telephone customer service to internal and external customers and route calls to the appropriate department when additional assistance is needed.
Communicate clearly with patients and staff by phone or electronic message, taking complete, concise, accurately spelled messages using correct medical terminology.
Respond to patient and insurance telephone inquiries to support timely reimbursement.
Prepare accounts and encounters for accurate billing; prepare, review, and transmit claims using automated systems or manual paper processes.
Provide required attachments to third-party claims, including authorizations and EOBs, to support timely payment.
Change system financial settings after primary insurance pays so co-payments and deductibles are generated to guarantors.
Identify and bill secondary payers.
Calculate disallowances and adjustments accurately by analyzing SYHealth contracts and Medicare and Medi-Cal reimbursement schedules and rates.
Enter and post adjustment write-offs by computer after obtaining required approval signatures.
Follow up on and appeal unpaid claims in a timely manner using system work lists, Remittance Advices, EOBs, and other payment documents.
Document analysis findings, phone calls, and correspondence in the online practice management system.
Maintain assigned Accounts Receivable at or below goal consistently.
Compose professional written correspondence with internal and external entities.
Attend meetings and training classes as required by departmental or facility management.
Perform special projects and participate in internal and external audits, which may require evening and weekend hours.
Follow departmental and facility policies and procedures, objectives, quality assurance programs, safety requirements, and infection control standards.
Perform other duties as assigned by the Director of Revenue Cycle, Business Office Manager, or Billing Supervisors.