Call Processing Reimbursement Specialist II (Bilingual - English/Spanish)

San Ysidro Health•San Diego, CA

22h•$28 - $35•Onsite

About The Position

The Call Processing Reimbursement Specialist II is responsible for the complete revenue cycle including billing medical, dental and/or hospital claims, and working directly with members over the phone. They are responsible for the follow-up performed on insurance balances to ensure accurate reimbursement and received in a timely manner. They are also responsible for self-pay collections and answering billing-related questions.

Requirements

Minimum of 3 years’ experience in a medical billing department
Must also demonstrate knowledge of CPT, HCPCs, and ICD-10 coding as well as Medical Terminology
High School Diploma or GED equivalent
Good oral and written communication skills
Provides positive customer service skills
Must possess the ability to communicate effectively in English & Spanish; both verbally and in all written communication
Experience in billing, CPT codes, and ICD-10, as well as Medical terminology
General office equipment to include PC and Software (Excel, Word, Office), phone, fax, etc.
Sedentary work requires sitting and use of the PC most of the day
Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.
Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

Nice To Haves

Certificate of completion of Billing and/or Coding

Responsibilities

Efficiently and actively provides excellent customer service by properly greeting, listening, assisting, directing, and closing each call
Log in and be ready to receive or make calls as directed by schedule as well as utilizing break codes appropriately as defined by the call management system
Demonstrates knowledge and understanding of the services provided and programs offered to answer questions and direct calls appropriately
Review, collect and update patient demographics and take appropriate actions to update identified changes
Must be well versed and up to date in all billing rules and regulations to ensure compliance with federal and state laws
Ensures accurate calculation of disallowances and adjustments through analysis of SYHealth contracts, Medicare and Medi-Cal reimbursement schedules and rates
The ability to read and interpret contract language is an essential function of the Call Processing Reimbursement Specialist II
Documents all analysis findings, phone calls and correspondence in the online practice management system
Prepares accounts and encounters for accuracy for billing; Prepare, review, and transmit claims using automated systems and manual paper claim process
Understands, recognizes, and effectively handles unique medical issues, urgent services and patient grievances and follows established protocols to resolve problems or determines escalation to supervisor
Must maintain assigned Accounts Receivable at or below goal on a consistent basis
The Call Processing Reimbursement Specialist II provides quality, efficient telephone customer service to internal and external customers and route calls to appropriate department for continued assistance as necessary
Responds to all patient or insurance inquiries timely to ensure reimbursement
Changes system financial settings once primary insurance has paid to ensure that co-payments and deductibles are generated to guarantors
Provides any required attachments to third party claims including authorizations and EOB'S to ensure timely payment for the third-party payer
Performs timely follow up and appeals on unpaid claims using the system work list and or Remittance Advices, EOBs, and other payment documents
Identify and bill secondary payers
After obtaining any needed approval, performs adjustment write off(s)
Functions as a resource on assigned Accounts Receivables to all staff and may assist with training
Attends meeting and training classes as required by departmental or facility management
Will be called upon to perform special projects and participate in internal and external audits that may require some evening and weekend hours
Adheres to established departmental and facility policy and procedures, objectives, quality assurance programs, safety, and infection control standards
All duties as assigned by the Director of Revenue Cycle, Business Office Manager or Billing Supervisors