Job description

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.
As a private, non-profit 501(C) (3) community health organization, we serve over 350k medical, dental, and behavioral health visits from more than 77k people annually. We do this in pursuit of our mission to improve the health and happiness of the communities we serve by providing quality care to all, regardless of situation or circumstance.
We have been doing this since 1969 and it is our employees that make this mission a reality. Regardless of the role, our team focuses on being compassionate, having integrity, being professional, always collaborating, and consistently going above and beyond. If that sounds like an organization you want to be a part of, we would love to have you.
ROLE OVERVIEW and PURPOSE
The Senior Insurance Biller will process medical billing for patients and third parties, including Medi-Cal, CHDP, Medicare, private insurances, Family Pact, Managed Care plans, and various other programs and funding sources. This role will correct coding processes and compliance measures as set by the organization, department, and industry. In addition, this role will provide expertise and direction when assisting other teammates in the department.
RESPONSIBILITIES

• Reviews progress notes to obtain payer measures and requirements information for proper submission compliance
• Reviews and obtains required information for missing and incomplete billings, such as missing DX, procedure codes, payer specific needs, eligibility screening, and coverage verification
• Creates and submits claims for clean billable charges and statements in compliance of correct coding initiatives and billing industry requirements
• Processes and monitors system claim status categories to ensure all transactions are captured for month end close
• Registers patients in the payment portal, as needed
• Reviews, processes, and obtains patient eligibility information to ensure accuracy and completion, including acquisition of authorization numbers, as needed
• Applies discounts to billing statements for patients eligible for the Sliding Fee Discount Program (SFDP), as needed
• Posts patient and insurance payments to account balance adjustments and write offs, as assigned
• Monitors and reports insurance payment denials, including coding issues and benefit changes
• Reviews and processes aging claims and denials, including claim tracers, corrected claim submissions, appeals, and consistent revenue flow
• Resolves escalated calls pertaining to account question and/or problems from the back phone line and patient phone lines
• Provides customer service internally and externally with professionalism, courtesy, and knowledge

• Responds to site, insurance, and patient correspondences related to billing in a timely manner
• Maintains department productivity, quality, and compliance standards
• Monitors monthly reporting of department processes and closing
• Assists supervisor with team workflow and productivity to assure department deadlines and expectations are met
• Trains and mentors new and current staff members
• Provides documented feedback on performance and progress to supervisor, as needed
• Assists supervisor with project oversight and review, as needed
• Provides payer/coverage research assistance for department’s development, as needed
• Attends and participates in required meetings, in-services, and educational workshops/trainings
• Functions at highest level according to credentials and competencies
• Contributes to the success of the organization by participating in quality improvement activities
• Responds promptly and with caring actions to patients and employees.
• Maintains professional working relationships with all levels of staff, clients, and the public
• Cooperates in accomplishing department goals and objectives
• Operates to instill confidence in our care and in our facilities to patients, fellow employees, and other stakeholders
• Impacts patient experience by demonstrating courteous and helpful behavior and a commitment to accuracy

EDUCATION/EXPERIENCE

• High school diploma/GED required
• Medical Billing or Cording Certification from an accredited school required
• Five years’ medical billing and claim follow-up experience in a healthcare environment required
• Experience working in a specialty and/or FQHC community clinic is preferred
• Bilingual (English/Spanish) preferred

Neighborhood Healthcare requires employees to be fully vaccinated (including a booster dose) against COVID-19 and demonstrate proof of vaccination/booster upon hire or receive approval for an exemption based on a medical reason, disability or religious belief. Proof of booster dose will be contingent upon booster eligibility.
Pay Range: $25.00 - $30.00 per hour, depending on experience (DOE)
Location: Escondido,California,92025,United States, Escondido, CA 92025

Location: Escondido,California,92025,United States, Escondido, CA 92025

Job Type: Full-time

Pay: $25.00 - $30.00 per hour

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