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

San Ysidro Health•San Diego, CA

11d

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 over the phone. The role follows up on insurance balances to ensure accurate, timely reimbursement, manages self-pay collections after insurance, and answers billing-related questions. The specialist provides telephone customer service, handles patient and insurance inquiries, prepares and transmits claims, identifies and bills secondary payers, and follows up or appeals unpaid claims. The position also documents account activity, maintains assigned accounts receivable at or below goal, and supports departmental projects, audits, meetings, and training.

Requirements

At least 1 year of experience in a medical billing department.
Knowledge of CPT, HCPCS, and ICD-10 coding, as well as medical terminology.
High school diploma or GED equivalent.
Bilingual English/Spanish proficiency.
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 billing, CPT codes, ICD-10, and medical terminology.
Experience and knowledge using Microsoft Office software.
Math ability to calculate and accurately analyze various accounts.
Ability to meet pre-employment requirements, including I-9, physical, positive background and reference check results, completed application, new hire orientation, and pre-employment PPDs.
Compliance with all mandated vaccinations and boosters.

Responsibilities

Demonstrate knowledge of San Ysidro Health services and programs to answer questions and direct calls appropriately.
Review, collect, and update patient demographics, taking appropriate action when changes are identified.
Provide excellent customer service by greeting, listening to, assisting, directing, and closing each call appropriately.
Recognize and handle unique medical issues, urgent services, and patient grievances in accordance with established protocols; resolve issues or escalate them to a supervisor.
Log in and be ready to receive or make calls according to the schedule, using call management system break codes appropriately.
Provide quality telephone service to internal and external customers and route calls to the appropriate department when further assistance is needed.
Communicate clearly with patients and staff by phone or electronic message, taking complete, concise, accurately spelled messages and 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 through automated systems and manual paper processes.
Provide required third-party claim attachments, including authorizations and EOBs, to support timely payment.
Change system financial settings after primary insurance pays so copayments and deductibles are generated to guarantors.
Identify and bill secondary payers.
Analyze SYHealth contracts and Medicare and Medi-Cal reimbursement schedules and rates to calculate disallowances and adjustments accurately.
Enter and post adjustment write-offs through computer input after obtaining approval signatures when required.
Follow up promptly and appeal unpaid claims 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 standards, and infection control standards.
Perform other duties as assigned by the Director of Revenue Cycle, Business Office Manager, or Billing Supervisors.