Billing and Collection Specialist

Duties and Responsibilities:

1. Prepare and submit claims to third-party payers, including Medicare, Medi-Cal, Denti-Cal, and commercial insurances.
2. Review claims for accuracy, ensuring compliance with payer-specific requirements and regulations.
3. Follow up on unpaid or denied claims, reprocessing them as necessary to secure payment.
4. Generate and distribute billing statements to patients and third-party payers.
5. Monitor accounts receivable, working diligently to reduce outstanding balances and increase collection rates.
6. Process patient payments, ensuring all transactions are accurately recorded and posted on the same day.
7. Balance daily batches and maintain accurate financial records.
8. Prepare and review encounter reports, addressing any discrepancies in visit documentation and billing codes.
9. Evaluate accounts for corrections, including adjustments, write-offs, and charge reversals, in line with established policies.
10. Collaborate and communicate with clinic administrators, front-line staff, and vendors to resolve billing issues and discrepancies.
11. Maintain open communication with the Billing Project Coordinator and Supervisor regarding claim status, workflow, and other critical billing matters.
12. Uphold confidentiality and comply with HIPAA regulations in all billing activities.
13. Identify areas for improving billing efficiency and accuracy, contributing to the overall financial health of the organization.
14. Stay up-to-date with changes in billing regulations, payer requirements, and coding guidelines to ensure continued compliance.
15. Perform additional duties as assigned.

Qualifications:

• Billing Degree or Certificate.
• High school diploma or equivalent (GED).
• 2-3 years of billing experience, with expertise in Medicare, Medi-Cal, Denti-Cal, and commercial third-party billing.
• Familiarity with ICD-10 coding guidelines.
• Strong interpersonal and communication skills, with the ability to collaborate effectively with managers, administrators, clinic staff, and vendors.
• Proficiency in Microsoft Word, Excel, and Outlook.
• Strong problem-solving skills and the ability to handle difficult situations professionally.
• Ability to manage multiple tasks and prioritize effectively to meet deadlines.
• Excellent interpersonal skills, with the ability to work independently and as part of a team.
• Commitment to maintaining confidentiality and ethical standards in line with HIPAA and other relevant regulations.

Preferred:

• Bilingual in English and Spanish.
• Experience working in a Federally Qualified Health Center (FQHC) setting.