Billing Specialist

Reports to: Controller | Full Time | Non-Exempt

About the Role

Western Sierra Medical Clinic is an engaging, enthusiastic, mission-driven organization dedicated to providing high-quality primary care to all members of our community. This includes the delivery of evidence-based preventative care, chronic disease management, and addressing urgent care needs for our pediatric and adult patient population.

Under general supervision, the Billing Specialist is responsible for timely submission of claims to insurance companies from a wide variety of medical providers and facilities, as well as monitoring and ensuring that payments for medical services are received in a timely manner. The Billing Specialist may also function as an intermediary between healthcare providers, clients, patients, and health insurance companies.

Responsibilities

• Reviews patient charges for accuracy and completeness; obtains missing information.
• Demonstrates knowledge of insurance, especially compliance with Medicare and Medicaid rules and guidelines.
• Identifies insurance company or proper party (patient) to be billed; identifies and bills secondary or tertiary insurances.
• Performs coding and billing tasks on a computerized health information technology (HIT) system.
• Handles provider and facility credentialing with third-party payers and maintains organized files and a credentialing progress grid.
• Performs third-party payers contracting duties as assigned.
• Utilizes a combination of electronic health record (EHR) and paper patient records to perform billing duties; maintains an accurate, legally compliant medical record.
• Processes claims as they are paid and credits accounts accordingly.
• Reviews insurance payments for accuracy and compliance with contract discounts.
• Reviews denials or partially paid claims and works with the involved parties to resolve discrepancies.
• Manages assigned accounts, ensuring outstanding/pending claims are paid in a timely manner, and contacts appropriate parties to collect payment.
• Assists patients and staff in completing sliding fee applications and processes the application in accordance with Western Sierra Board-approved policy.
• Communicates with healthcare providers, patients, insurance claim representatives, and other parties to clarify billing issues and facilitate timely payment.
• Consults supervisor, team members, and appropriate resources to solve billing and collection questions and issues.
• Maintains work operations and quality by following standards, policies, and procedures; escalates compliance issues to supervisor.
• Prepares reports and forms as directed and in accordance with established policies.
• Performs a variety of administrative duties, including but not limited to: answering phones; faxing and filing confidential documents; and basic Internet and email utilization.
• Provides excellent and professional customer service to internal and external customers.
• Functions as a contributing team member while meeting deadlines and productivity standards.
• Submits twice-daily claims batches to all insurance carriers.
• Prepares insurance adjustments reports for the Chief Financial Officer/Controller.
• Assists in insurance contract renewals and additions, as needed.
• Answers and directs phone calls.
• Documents all pertinent information in the patient’s electronic medical record according to WSMC’s policies and procedures.
• Upholds WSMC’s Policies and Procedures, infection control standards, applicable state, federal, and local laws.
• Participates in quality improvement activities and interdepartmental quality improvement team efforts as assigned.
• Contributes to overall Community Health Center efforts in quality improvement toward higher-quality, more cost-effective healthcare for patients and improved quality of work-life for staff members.
• Performs other duties as assigned.