Western Sierra Medical Clinic is a mission-driven organization dedicated to providing high-quality primary care to pediatric and adult patients.
The Billing Specialist is responsible for the timely submission of claims to insurance companies for a wide variety of medical providers and facilities, and for monitoring payments to ensure medical services are received and processed in a timely manner. This role may also serve as an intermediary between healthcare providers, clients, patients, and health insurance companies.
Key responsibilities include claims submission, payment posting, denial resolution, account follow-up, patient and staff communication, credentialing support, contract support, administrative tasks, and participation in quality improvement efforts.
Other duties as assigned.
Qualifications and Duties
- Review patient charges for accuracy and completeness and obtain missing information.
- Knowledge of insurance rules and guidelines, especially Medicare and Medicaid compliance.
- Identify the correct billing party and process secondary and tertiary insurance claims.
- Perform coding and billing tasks in a computerized health information technology system.
- Support provider and facility credentialing with third-party payers.
- Assist with third-party payer contracting duties as assigned.
- Use electronic health record and paper records to perform billing duties while maintaining accurate, compliant medical records.
- Process payments, credit accounts, and review insurance payments for accuracy and contract compliance.
- Review denials or partially paid claims and work with involved parties to resolve discrepancies.
- Manage assigned accounts and follow up on outstanding or pending claims.
- Assist with sliding fee applications and patient billing questions.
- Communicate effectively with providers, patients, insurance representatives, and other stakeholders.
- Prepare reports and forms according to established policies.
- Perform administrative tasks such as answering phones, faxing, filing, and email/internet use.
- Meet deadlines and productivity standards while maintaining professionalism.
- Uphold clinic policies, procedures, infection control standards, and applicable laws.
Location
California, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago