Medical Billing Specialist: Revenue Cycle Operations

Hoag•Costa Mesa, CA

2d•$25 - $36•Onsite

About The Position

The Medical Billing Specialist role is part of the Revenue Cycle Operations team, focusing on resolving inquiries related to claims, eligibility, and authorization. This position involves working with multiple parties to ensure records are accurate and up-to-date, adhering to first-call-resolution standards and Hoag guidelines. The Specialist will ensure accuracy, report and resolve issues, and maintain compliance with regulatory guidelines and health plan requirements, documenting all actions in accordance with HIPAA. This role may also involve assisting with customer service, member services, and collaborating with providers and billing offices. Additionally, the Specialist will help identify and report issues to the management team to minimize rework and address front-end process issues. Within Revenue Cycle, responsibilities may include maintaining databases, auditing information, and processing patient payments. The role also involves following up with insurance companies on outstanding claims and creating/sending patient statements. In the Clinic MSO setting, the Specialist handles a significant volume of calls daily from various healthcare stakeholders, documents interactions per HIPAA, supports the claims department with mail and correspondence, and assists with mail distribution. A key aspect of this role is interacting positively and collaboratively with internal and external partners, especially in challenging situations, demonstrating a caring and empathetic attitude. The Specialist will support the claims team in implementing efficiency initiatives and assist with provider and member customer service as needed.

Requirements

Experience in medical billing and revenue cycle operations.
Knowledge of claims, eligibility, and authorization processes.
Familiarity with HIPAA guidelines for documentation and patient data handling.
Ability to handle a high volume of calls (35-40 daily).
Strong customer service and interpersonal skills, with the ability to interact positively and collaboratively, especially in demanding situations.
Proficiency in documenting actions and maintaining databases.
Ability to follow up with insurance companies and process patient payments.
Experience with mailroom operations, including pick-ups, distribution, and handling of correspondences.
Ability to work with providers, billing offices, health plans, and members.

Nice To Haves

Experience working in a Hoag Clinic MSO environment.
Experience in identifying and reporting process issues to management.
Ability to assist in implementing initiatives for claims processing efficiency.

Responsibilities

Resolving inquiries related to claims, eligibility, and authorization.
Working with multiple parties to ensure records are up to date.
Ensuring first-call-resolution standards are followed and referring/following up as per Hoag guidelines.
Ensuring accuracy, reporting issues, and working to resolve them.
Ensuring compliance with regulatory guidelines and health plan requirements.
Documenting actions taken following HIPAA guidelines.
Assisting in providing customer service, member services, and others in working with providers/billing offices when needed.
Identifying and reporting issues, working with the management team to help minimize re-work and address front-end process issues.
Maintaining databases and audit information.
Working with patients to process patient payment.
Following up with insurance companies on outstanding or unpaid claims.
Creating and sending statements to patients.
Handling 35-40 calls daily from healthcare providers, health plans, billing companies, and members on inquiries related to claims, eligibility, and authorization.
Documenting all incoming calls following HIPAA guidelines in handling patient data.
Supporting the claims department by preparing claim receipts and correspondences received in the Hoag Clinic MSO mailroom.
Assisting with daily pick-ups and distribution of mail and correspondences from dedicated post office boxes, fax machines, e-fax, secure file transfers, as well as sending provider EOBs, member letters, misdirected claims, and other letters sent by the Claims team.
Interacting in a positive and collaborative manner with internal and external partners, especially in demanding and tense situations with providers and patients exhibiting a caring, empathetic, and patient attitude.
Supporting the claims team in implementing initiatives in improving claims processing efficiency.
Assisting in provider customer service, member services, health plan, and other customers including making and answering phone calls to providers/billing offices when necessary, based on team guidelines.
Performing other duties as assigned.