POSITION TITLE: Billing Specialist DEPARTMENT: Finance REPORTS TO: Revenue Cycle Manager SCHEDULE: Full Time; Monday- FridayLOCATION: Davis, CA PAY RANGE: $24.06 to $29.41 hourly About CommuniCare+OLEEstablished in 2023, CommuniCare+OLE is the result of a union of two health centers with deep roots in their respective communities and reputations for providing high-quality primary care to all, regardless of insurance or ability to pay: OLE Health of Napa and Solano Counties and CommuniCare Health Centers of Yolo County. Building on a legacy established by both organizations in 1972, CommuniCare+OLE is a network of federally-qualified health centers with 17 sites across Napa, Solano, and Yolo Counties. It offers comprehensive care, including medical, dental, behavioral health and substance use treatment, nutrition, optometry, pharmacy, care coordination, referrals, and enrollment assistance to more than 70,000 individuals, and no one is turned away due to lack of insurance, immigration status, or ability to pay. Many services are offered outside of its sites, including mobile health, home visiting, and community and school-based programs.BENEFITS
- Medical, Dental, Vision Coverage
- Employer covers 90% of employee medical, dental and vision premium and 50% of dependent premium
- 18 days of PTO (Vacation & Sick)
- 10 Paid Holidays + 1 Float Holiday
- 4% Employer Match for 403(b) retirement plan
- Tuition Reimbursement of up to $2,000 per Calendar Year for part-time and full-time employees (prorated per Full-Time Equivalent)
- Life & Accidental Insurance Coverage
- Employer contribution for Health Savings Account
- Flexible Spending Account (FSA) and Limited FSA Options
The following statements are intended to describe the major elements and requirements of the position and should not be taken as an all-inclusive list of responsibilities, duties, and skills required of individuals assigned to this job.JOB SUMMARY: The Billing Specialist assists with the day-to-day operations of the Billing Department. This position works with a team of Operations and Program staff members to ensure that the organization-wide billing is properly performed.EDUCATION, EXPERIENCE, TRAINING
Associate's degree (A. A. / A. S.) or equivalent from two-year College or technical school.One to two years related experience and/or training; or equivalent combination of education and experience.Ability to read and understand explanation of benefits (EOBs) from various insurances.One or more years' experience working in a healthcare setting is preferred. Experience in an FQHC environment a plus.OCHIN EPIC experience a plus.ClaimRemedi experience a plus.KNOWLEDGE OF WORK1.Knowledge of health insurance programs, coverage offered and third-party reimbursement mechanisms, including Medicare, Medi-Cal, PPO, HMO, IPA, PMG, Military and Veteran2.Knowledge of Payer/Provider portals; verifying patient eligibility and covered benefits.3.Knowledge of adjustment codes, remark codes and denial reasons.4.Knowledge of ICD-10, CPT and HCPCS coding systems.5.Knowledge of electronic claims filing through Practice Management software, claims submission and 837 file review and trouble shooting through clearinghouse.DUTIES AND RESPONSIBILITIES1.Prepares and submits clean claims to various insurance companies either electronically or by paper.2.Verifies appropriate documentation of billable services on each claim according to specific payer requirements in an effort to minimize rejections and denials3.Ensure completion of documentation and coding on charges entered in patients accounts for a correct and complete billing claim.4.Researches, corrects and re-bills denied claims. Accurately and efficiently processes request for denied claims information using website portals and outbound phone calls for all Commercial, Medicare and Medicaid (Medi-Cal) insurance payers5.Follows up with insurance company and/or clearinghouse on unpaid or rejected claims. Resolves issue and re-submits claims.6.Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal. 7.Refer to payer's contract, Provider Manual and/or Billing Manual/Procedures as needed to confirm billing requirements, appeal procedures, etc.8.Review and submit medical records and other documentation- to ensure services meet required insurance standards and to respond to insurance medical record requests in a timely manner.9.Prepares and submits secondary and tertiary claims upon processing by primary insurer, according to payer requirements.10.Daily collections - obtaining status through insurance representatives (and online resources), maintaining schedule of each policy reimbursement to ensure uniform and highest paying reimbursement11.Assists in the completion of mandatory reports and special billing projects at the direction of the Revenue Cycle Manager.12.Works with clinic and finance staff to provide accurate assignment of patient services revenue into all clinic sites and programs.13.Ensures the accurate distribution and posting of all patient services revenue to correct sites and programs in the Electronic Health Record.14.Prepares patient statements for charges not covered by insurance. Ensures statements are mailed according to policies and procedures.15.Provides billing training and on-going billing support to new clinical staff and Patient Service Representatives, as needed.16.Assures that any adjustments and write-offs to accounts are done according to office policy and procedure.17.Follow Federal, State and local protocols, procedures, and billing guidelines18.Keeps current on all updates for state and local programs and other payer requirements by reviewing daily/monthly newsletters and bulletins19.Other duties as assigned.