Billing Specialist

Billing Specialist

This position is responsible for providing timely and efficient follow-up with all payer types for all unpaid claims, consistent with the mission and philosophy of One Community Health.

This role is on-site during the training period (4-6 weeks), then hybrid with a requirement to be on-site 1-2 days per week.

Work Location : Midtown Sacramento, CA (95811)

Essential Functions

• Conduct insurance verification and validation as needed to ensure eligibility and benefits are accurately prepared for claim submission, adjudication and reimbursement.
• Review first initial claim scrub and billing to the clearinghouse utilizing billing and practice management software.
• Employ effective and efficient billing techniques, take a proactive and self-directed approach to resolve all types of billing edits.
• Validate claims and make necessary corrections to send out clean claims to all payers electronically and / or manually, via paper submission.
• Review self-pay encounters for accurate billing.
• Follow up on outstanding open encounters for all payers, call insurance claims department to obtain more detailed information on denials and on next steps to reprocess and reimburse outstanding claims.
• Research and resolve patient issues, respond to inquiries by OCH staff, and assist with patient statements and address patient inquiries by responding via calls on billing line, MyChart or email.
• Work with management in identifying, researching, and resolving issues which may lead to inaccurate or untimely filing of claims, claim rejections, and / or other billing and collections issues which may arise.
• Posts patient payments and electronic insurance remittances to the appropriate invoice with accuracy and timeliness, notifying management of any erroneous payment, denials or payment / claim processing issues
• Completes appropriate batch summary sheets and balances all receipts to deposits.
• Posts insurance explanations of benefits, including zero payments, taking the appropriate contractual adjustments reflective of OCH contracts at the time of service.

Education / Experience Required

Preferred

One Community Health endorses and supports the Americans with Disabilities Act of 1990 (ADA) and the California Fair Employment and Housing Act (FEHA) and is committed to providing reasonable accommodations to qualified individuals with disabilities who are applicants or employees who need accommodations. If you require and accommodation due to a disability to complete this application or you are experiencing difficulty submitting your application, please contact us at ochhumanresources@onecommunityhealth.com.

We only employ US citizens and non-US citizens authorized to work in the United States in compliance with federal law.