Job Type Full-time Description Salud Para La Gente (SALUD) provides high quality, comprehensive and cost-effective medical, dental, behavioral health, optometry and other services to underserved, low-income communities in the Monterey Bay area, including Santa Cruz and Monterey Counties. SALUD began in Watsonville in 1978 as a storefront free clinic, and became a FQHC (Federally Qualified Health Center) in 1992. With four health center sites, satellite and school-based health centers and over 400 employees, we provide high quality services to patients of all ages. We offer a competitive salary and benefits package and a collaborative culture that values excellence, achievement, innovation and compassion. We are seeking an experienced Billing Clerk to process assigned super bills and perform other billing functions. This position requires the ability to perform detailed work in a consistently accurate and timely manner. The ideal candidate will embrace our mission, vision and values, and demonstrate sound independent judgment and think independently and analytically. The selected candidate will possess knowledge of basic and computerized accounting procedures, especially relating to billing of health insurances and state programs. Responsibilities include, but are not limited to, the following:
Consistently adheres to SPLG's communication guidelines and expectations with patients, peers, and supervisors. Collaboratively works with patients through SPLG's communication guidelines to positively affect their health outcomes. Enters, reviews, and makes necessary changes to all patient registration information in the practice management system in accordance with established procedures. Ensures that all matters related to patient account information are handled confidentially, effectively, efficiently and in accordance with regulations and contracts. Researches and answers any questions regarding account balances, bills, or correspondence on a patient's account in a timely and professional manner and with regard to patient confidentiality. Using proper phone etiquette answers incoming calls courteously and professionally. Maintains expertise in registration and charge posting in all Salud's specialties and sub-specialties for all payers. Provides administrative expertise and technical assistance to the Patient Service Coordinators as required for financial and insurance issues. Processes Salud's encounters/claims: - Reviews all encounters. If errors are found, responsible to coordinate with clinical support staff and providers to make corrections in order complete a timely daily close.
- Runs unresolved encounter reports that require monitoring and action on a daily basis, and follows up with the appropriate person(s) in an effort to resolve outstanding encounters and claims.
- After final review of encounters, prepares the batch for electronic submission.
- Coordinates with fellow billing clerks to finalize electronic encounter/claim submission.
- Maintains a log identifying all errors found while processing encounters. Reviews daily to identify patterns. Reports information monthly to Lead, Supervisor or Manager.
- Reviews health insurance claim to ensure accuracy of payment, denial, rejection received based upon contracts on file, payer guidelines and Salud's policies/procedures.
Processes Salud's aged receivables and claim denials: - Runs all reports that require monitoring of claims with appropriate entity in an effort to collect outstanding claims following Salud's policies and procedures.
- Coordinates required coding changes that may impact payment of a claim in the practice management system.
- Maintains all paper correspondence including Explanation of Benefits from Insurance Companies organized and filled on a weekly basis.
- Reviews health insurance claim to ensure accuracy of payment, denial, rejection received based upon contracts on file, payer guidelines and Salud's policies/procedures.
- Works in coordination with Patient Account Receivable to ensure accurate payments are received. Follow up on all denials received to resubmit accurate data.
When applicable Billing Clerk may participate in individual or group meeting/trainings related to billing or revenue cycle practices. Provides office support and back-up for the billing department functions as needed, such as posting charges, prepares claims for billing and completing electronic billing batches. Coordinates with clinical staff (Providers, Support Staff and Front office staff) via tasks, phone, email or in person the following corrections: Registration Missing charges Missing Forms (related to billing) Diagnosis codes CPT, CDT, HCPCS codes Informs patients of Clinic policies regarding minimum payment requirements and financial arrangements such as sliding fee scales and payment contracts. Advises the Finance Department/CFO regarding all parties with outstanding balances to assist in determining which accounts are appropriate for payment plans or write-off. If requested, will research or produce billing related reports for Finance Staff. If requested, will collaborate with Data Systems staff to provide billing expertise to assist with the production of billing related reports. Analyzes current flow and provide suggestions for workflow improvement. Maintains effective working relationship with a diverse employee, patient and business population. Performs all duties with high degree of accuracy 20. Performs billing related administrative tasks as needed to support the clinic operation including faxing, scanning or sending patient financial records for subpoenas or patient requests. 21. Collects delinquent accounts by establishing payment arrangements with patients, monitoring payments; following up with patients when payment lapses occur. 22. Adheres to the SPLG Mission, Vision, and Values, Standards of Conduct and HIPPA principles. 23. Performs other duties as assigned. Requirements MINIMUM QUALIFICATIONS:
- High School Diploma
- Two years of health insurance billing experience, preferred.
- One year experience working with the following state programs and rules:
- MediCal
- Medicare
- Child Health Disability Program (CHDP)
- Family Pact
- Commercial Insurances
- Every Woman Counts (EWC)
- Managed Medi-Cal
- Bilingual Spanish/English.
- One year experience with standard ICD-10 medical and dental coding (experience to have occurred within the past four years).
- Completed/Passed Medical Terminology Course.
- Excellent customer service skills (for both internal and external customers) is required.
- Possession of a valid California Class C Driver's License or must be able to provide suitable transportation. Transportation between sites may be required.
** Individuals hired on or after March, 2018, who have not successfully taken a Medical Terminology class (to be confirmed by proof of taking and passing class with a grade of C or better) will be placed at the Billing Clerk scale that was in effect prior to March, 2018. They will have nine (9) months to successfully complete the class with a grade of C or better and they can use the Education Career Development money to pay for the class.** PHYSICAL DEMANDS:
- Standing, walking, sitting, typing, reaching, bending, moving and/or lifting up to 50 pounds.
SALARY & BENEFITS Salary Range: $20.35 - $24.75 per hour; with Medical Terminology the range is $23.03 - $28.00 per hour Full benefits package, including Medical, Dental, Vision, and Life Insurance, Voluntary Long Term Disability, 401(k) with employer contribution, Holiday Pay, and PTO. **Salud is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Salud is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, contact the Salud Human Resources Department, [831-###-####, and
[email protected]]. Salary Description $20.35 - $28.00
