Billing Specialist, Lead

About the position : The Billing specialist Lead is responsible for the processing and submission of clean, accurate claims (across all service lines, e.

g., medical, dental, vision, etc.) to third party payers on behalf of La Clinica

Major Areas of Responsibility include but are not limited to :

• Escalates items identified missing information on claims with clinicians to provide accurate, missing information (quantities, codes, etc.) to billers.
• Understanding of the various managed care contracts in place (for each servicing county), to assist with determining if claims were adjudicated properly.
• Exercise excellent customer service abilities while interacting with team, internal and external customers while resolving issues.
• Discuss matters with the Director as they occur related to day-to-day operations of the Business Office.
• Attend department meetings and trainings as directed.
• Additional duties as assigned.
• For outstanding claims identified through Aging Reports, research and re-submit overdue claims / statements within established timeframes.
• Identify credits, adjustments, and write-offs, providing required documentation for approval of management.
• Ability to identify errors in the electronic health record as it applies to the claim.
• Ability to respond to & resolve patient inquiries / discrepancies, submit request for refunds when necessary.
• Review and resolve payments misapplied, denials and claim rejections; make recommendations for claim edits when necessary.
• Work in cooperation with Director in initiating process improvement within PFS / Billing department.
• Provides outstanding service to all providers and fosters teamwork through improvement and innovation.

Requirements, Knowledge :

Demonstrated knowledge and experience with third party reimbursement programs, and the ability to identify problems with payers (e.

g., Medicare, Medi-Cal, and other third-party carriers).

• ICD-10, CPT Code, and A / R knowledge.
• Must be able to explain and apply billing policies and procedures for various programs.
• Must be proficient with Microsoft Word and Excel.
• Must have a thorough knowledge of working within an EPM / EMR (electronic medical record system).

Other Certifications and Experience

• Must have 3-5 years in a medical environment performing billing or medical accounts receivables functions. Previous FQHC experience preferred, not required.
• Must have experience with billing and collection practices.
13 days ago