| Location | Alhambra, CA |
Position Summary
The Medical Biller stationed at administration office, will provide support services needed to complete the claim adjudication
process, by reconciliation.
Schedule:
Full-time (Non-Exempt)
Flexible, may require some evening and weekends
Primary Duties and Responsibilities
Submit/generate claim(s) file(s) to health insurance plans, both paper and electronic on a weekly basis and ensure
their receipt (e.g. PM160, CMS1500, email ticket, volser etc…).
Submit/generate encounter(s) to the appropriate IPA/ health plans, both paper and electronic on a weekly basis and
ensure their receipt (e.g. PM160, CMS1500, email ticket, volser etc…).
Post Remittance Advice and Explanation of Benefits, both paper and electronic on a weekly basis.
Organize superbills (e.g. file, scan, label, etc…).
Interface with billing/clinic staff and providers to obtain any required information needed to enter and bill/rebill a
claim (e.g. correct payor on superbill, authorizations, diagnosis, etc…).
Generate/re-generate superbills (e.g. hospital round etc…).
Generate/create various reports/invoice (e.g. hospital round, MAOF, "Daily Superbill Report", etc…).
Adjudicate all claim types.
Secondary Duties
Provide back-up support to clinical biller, ensuring claim deadlines are met by creating claims entering all superbills
generated on a daily basis from clinic site(s).
QA superbills for accurate data entry (e.g. eligibility, payer, diagnosis, etc…).
Ensure completeness of claims for proper payment (e.g. PM160, CMS1500, attachments etc…).
Provide superbills or any attachment(s) requested (e.g. rebilling, HEDIS, superbills for audit, etc…).
Contact insurance vendors (e.g. eligibility, denials, claims submission, etc…).
Assist in billing projects.
Attend trainings, meeting, workshops and webinars as needed.
Provider back-up support to receptionist is out.
Will perform other related duties as assigned by the Billing Supervisor, Billing Manager, Controller, Finance Director
or Executive Director.
Minimum Requirements
Microsoft Office/Word/Excel/Outlook
Excellent Communication Skills
Excellent Customer Service Skills
Knowledge of Medi/Cal reimbursement guidelines preferred
Bi-lingual Spanish/English (preferred)
Ability to work as a team player and work independently
Reliable transportation
Must be able to travel from facility to facility
This position requires 10 % travel outside the local area.
Required Education/Experience and/or Licensure/Certification
High school or GED equivalent
Certificate in medical billing
Knowledge of HCPCS, CPT and ICD9
Medical terminology
Commitment to goals and philosophy of Northeast Community Clinic
Valid State Identification
Physical Requirements and Working Conditions
OSHA Category 3 - Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to
blood, body fluids, or tissues are not a condition of employment.
The work is majority of the time sedentary in nature.
The employee is regularly required to communicate, frequently required to use repetitive motions, move, remain
stationary, regularly push, pull and lift up to 20 pounds and occasionally push, pull and lift up to 40 pounds.
Must possess mobility to work in a standard office/clinic setting (in some cases both settings) and to use standard
office/clinic equipment, including a computer, stamina to maintain attention to detail despite interruptions, read
printed materials and use a computer, and communicate in person and over the telephone.