Medical Biller

Astrana Health•Alhambra, CA

1d•$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 What You'll Do 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.

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.