Insurance Billing Clerk

Overview Job Details: Full Time, Day shift, location San Manuel - Grand Terrace, CA 92313. Education: HS Diploma required; a diploma in Medical Coding and Billing is preferred. Certification as a Certified Professional Biller (CPB) is required. Salary range: $22.00 - $23.00 per hour. Travel: None. Reports to Revenue Cycle leadership. Must be able to work with the Indian Community and be sensitive to Indian culture and needs. Responsibilities Submit claims to Medicare, Medi-Cal, commercial insurers, managed care, and other third-party payers accurately and promptly. Monitor claim status, resolve billing issues, follow up on unpaid claims, and support revenue cycle performance while ensuring compliance with payer, federal, state, and organizational requirements. Collaborate with providers, coding staff, patient registration, payment posting, denials/appeals management, collections, insurance credentialing, and insurance companies to optimize reimbursement. Utilize Practice Management (PM) system to review, edit, and submit claims through Waystar or designated clearinghouse. Review ERA and claim status reports; research claim issues using Waystar tools; correct demographic, coding, and billing errors; and reconcile claims with payers. Escalate recurring clearinghouse or payer issues to revenue cycle leadership; assist with payer-specific billing requirements and clearinghouse updates. Ensure timely filing deadlines and resubmit corrected claims as necessary; contact insurance companies for claim status and reimbursement issues; document all account activities. Analyze denials to identify root causes, submit corrected claims and appeals with supporting documentation, maintain denial-tracking logs, and assist with denial reduction efforts. Process aging reports, assist with collections and account resolution, and escalate complex reimbursement issues as needed. Maintain productivity and quality standards; support process improvements to reduce denials and increase cash collections; ensure HIPAA compliance and patient confidentiality. Follow Medicare, Medi-Cal, managed care, and commercial payer billing regulations; prepare, review, and submit paper claims when required. Communicate effectively with internal departments regarding claims issues; respond professionally to patient and payer inquiries; assist patients with billing and insurance questions. Review diagnosis and procedures; ensure claims have the correct provider information and coding to match FQHC guidelines for Medicare and Medi-Cal claims processing. Submit all secondary insurance on medical claims with remittance advice attached; adjust accounts as needed under supervision. Attend insurance seminars or staff meetings as needed; work weekends and evenings if required; perform other duties as assigned with training and competency documentation. Qualifications Education: High school graduate or equivalent. Diploma in Medical Coding and Billing preferred. Certification: CPB required. CPR (BLS) certification through AHA or American Red Cross (may be obtained prior to orientation or within 90 days of employment). Experience: Minimum two years of experience billing Medicare, Medi-Cal, and Managed Care Plans (IEHP, Molina, Blue Shield, Kaiser) including FQHC encounter billing; minimum two years of experience with medical terminology, ICD-10-CM, CPT, HCPCS; experience with NextGen Practice Management, Waystar Clearinghouse, and electronic remittance systems preferred. Knowledge: Insurance billing requirements, including Medicare, Medi-Cal, managed care, commercial and Tribal FQHC billing; ability to interpret EOBs/ERAs; familiarity with cash/receipt procedures; strong problem solving and communication skills. Skills: Detail-oriented, strong organizational skills, effective written and verbal communication; proficient in computers and office software; willingness to receive Native American cultural competency training. Ability: Maintain confidentiality; multi-task and meet deadlines; work collaboratively with internal and external partners; maintain professional relationships and deliver strong customer service. Schedule and Compensation Schedule: Monday-Thursday 7:00am-4:00pm; Friday 7:00am-1:00pm. Hybrid telework eligible after 90-day introductory period, subject to supervisor approval and organizational needs. Appointment Type: Full-Time, Non-Exempt Compensation: $22.00–$23.00 per hour ($45,760–$47,840 annually, depending on experience and internal equity). Clinic Location San Manuel Indian Health Clinic (11980 Mt. Vernon Ave., Grand Terrace, CA 92313) #J-18808-Ljbffr Riverside-San Bernardino County Indian Health Inc