Medical Biller

Astrana Health, Inc.•Alhambra, CA

5d•$20 - $25•Hybrid

About The Position

We are currently seeking a highly motivated Medical Biller. This role will report to our Director - Revenue Cycle and enable us to continue to scale in the healthcare industry. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team

Requirements

High school diploma or GED equivalent
3+ years of medical billing experience required
Demonstrated strong knowledge of commercial and/or regulatory claims billing including relevant Federal, State, and local laws and regulations and requirements.
Strong knowledge of third-party reimbursement, government reimbursement regulations, third party and patient billing, managed care agreements, account follow-up, account resolution, and cash applications.
Proven extensive knowledge of EDI billing systems and third-party payor billing process management.
Proven history of proactively identifying, resolving, and escalating issues that impact business outcomes.
Possess complete understanding of the billing/collection process to resolve complex, outstanding claims.
Excellent critical thinking, organizational and time management skills with a strong attention to detail, accuracy and follow through.
Demonstrated strong and persuasive verbal, written and interpersonal communication skills.
Proven track record showing good decision-making skills based upon a mixture of analysis, experience, and judgment.
In-Depth knowledge of Microsoft Office (Teams, Outlook, Excel etc)
Basic Data Analytic Skills (Power Query, Pivot Tables etc)
Proven ability to work collaboratively in a team environment in a positive and professional manner.

Nice To Haves

Experience supporting Quality/Risk Adjustment initiatives (HCC, RAF, gap closure) preferred
Familiarity with Quality measures (HEDIS/Stars)
Medical billing course certificate or coding certificates a plus

Responsibilities

Ensures accounts are billed accurately and timely by providing oversight and direction to Billing staff.
Maintain current knowledge of billing systems and payor systems, including applicable federal/state laws, regulations, and third-party reimbursement policies and practices.
Update trackers and live spreadsheets of billing progress and project deadlines
Claim submission: Prepare and submit claims to insurance companies using billing software.
Insurance verification: Verify patient insurance information, eligibility, and benefits.
Payment and invoicing: Process payments, generate invoices for patients, and manage payment plans.
Claims management: Follow up on denied or unpaid claims, resolve discrepancies, and handle appeals.
Record keeping: Maintain accurate patient and billing records and ensure compliance with regulations.
Project coordination: Assist in organizing project activities, schedules, and tasks to ensure timely completion.
Documentation: Prepare and maintain project documentation, such as plans, budgets, and status reports.
Performs other duties as assigned.