Senior Billing Specialist

Job Description

Job Description

Work Location : Sunnyvale, CA -Onsite, 5 days per week

Pay Range : $70,000 - $100,000

Our Company :

Founded in 2010, iHealth is dedicated to empowering people to live healthier lives. The company is a leader in designing and manufacturing consumer-friendly, mobile personal healthcare products connected through the cloud that allows consumers to easily measure, track, and share vital health information with their doctors. With a focus on delivering high-quality and accessible products, iHealth is at the forefront of the digital health revolution.

In 2018, iHealth established the Unified Care program to address the issue of managing chronic diseases. iHealth Care specialists support patients beyond the doctor’s office with chronic conditions via Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) to achieve better health outcomes.

In November 2021, iHealth's COVID-19 Antigen Rapid Test received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) for over-the-counter sales. Since then, iHealth has emerged as a key supplier of at-home COVID tests to the federal government, state governments, nonprofits, and individual consumers. With its commitment to helping people lead healthier lives, iHealth is poised to continue driving positive change in the healthcare industry.

Summary :

This position performs complete health insurance payer analysis with respect to medical billing and reimbursement functions and is responsible for all aspects of payer research, communicate and manage complex payer and industry changes that impact the iHealth’s revenue cycle for Remote Patient monitoring, Chronic care management and Medical Nutrition Therapy services and its operations or strategies.

Duties and Responsibilities :

Confirm patient benefits and insurance eligibility by making calls to the insurance provider

Follow and adhere to all regulations and guidelines set by Medicare, State programs, and HMO / PPO, etc.

Engage in end-to-end billing process, including charge entry, claim submission (including 837's and 1500 forms), payment posting, and accounts receivable management and extract reports from billing software

Engage in follow-ups with insurance companies and medical groups to address outstanding claims and denials, ensuring the resubmission of claims & appeal for payment

Develop, implement, and execute departmental procedures and processes

Collect reimbursements and analyze the revenue data to report trends related to errors & denials

Use data to identify trends, areas for improvement, and opportunities for revenue growth

Generate insurance reimbursement reports and analytics on key billing metrics, providing insights into the internal and external stakeholders on financial health of the organization

Analyze and identify opportunities to optimize revenue capture and reduce revenue leakage

Ensure compliance with healthcare billing regulations and stay current with changes in billing and coding guidelines to ensure accurate and compliant billing practices

Conduct detailed data audits and clean-up as scheduled and as needed

Analyzes patient billing records for completeness and accuracy and obtains additional information and clarification as necessary

Conduct billing training for internal and external stakeholders and maintain adequate documentation of meeting

Implement strategies to improve claim acceptance rates and reduce denials and enhance the overall billing experience for customers

Collaborates with internal teams, supporting the efforts and needs of other departments in a team-oriented approach. Works closely with IT teams to implement technology enhancements aimed at improving billing efficiency.

Resolves billing discrepancies by conducting further research and correcting errors

Maintain organized documentation of all billing and invoicing activities

Sending out invoices and maintaining a tracking system of incoming and late payments

Following up on late or missed payments and initiating late payment notices to relevant parties

Adjusting patient bills by reviewing remittance advice

Maintain compliance with HIPAA (Health Insurance Portability and Accountability Act of 1996)

Perform other related duties as required or requested

Minimum Qualifications

Bachelor's degree in accounting, health care administration, finance, business, or related field, with 5+ years of experience in an office environment or healthcare-related field

Knowledge of CPT / ICD-10 / HCPCS codes and EHR systems such as EPIC, Kareo, eCW, Office Ally, Practice fusion, Athena, AdvanceMD, etc.

Proficient in medical terminology and insurance plans

Experience with process improvement, quality control, data analysis and / or reporting

Integrity and respect for confidentiality and privacy

Attention to detail and the ability to work with a variety of databases

Demonstrates the ability to work independently, is self-motivated, and self-directed with excellent verbal and written communication and documentation skills

Demonstrates strong organizational and time management skills, enabling effective prioritization of workflow to meet client requirements. Possesses excellent customer service skills to ensure client satisfaction.

Ability to analyze problems and devise strategic solutions

Experience with using Google Docs, Sheets, Slides and Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)

Equal Opportunity Statement

iHealth Labs is committed to diversity in its workforce and is proud to be an equal opportunity employer. iHealth Labs considers qualified applicants without regard to race, color, religion, creed, gender, national origin, age, disability, veteran status, marital status, pregnancy, sex, gender expression or identity, sexual orientation, citizenship, or any other legally protected class. iHealthLabs is an Affirmative Action and Equal Opportunity Employer.

Please reference below for more information : https : / / www.eeoc.gov / sites / default / files / 2023 -06 / 22- 088_EEOC_KnowYourRights6.12ScreenRdr.pdf and https : / / www.dol.gov / ofccp / regs / compliance / posters / pdf / OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf