Billing Specialist I

Billing Specialist

La Clínica de La Raza is a community-based health center committed to providing culturally appropriate, high-quality, and accessible health care to the diverse communities of the San Francisco Bay Area. We have spent over 40 years advocating for and creating a health home for the many that have been denied access to care. As health care activists, we are dedicated to making sure individuals who do not have health coverage get the same level of quality healthcare as those who have it. From our genesis as a community health center in 1971, we understood that we cannot heal our communities without also addressing the economic and social factors that affect health. Many times, this requires that we go outside and provide services in other settings to build the bridge that links individuals to our health center for preventive and primary care. Over 90,000 individuals come to La Clínica because it is a welcoming place that addresses the whole person, coordinating and connecting them to a broad network of services to improve and maintain their health and well-being. While we are still known for our activism and spirit of social justice, we are also proud to have grown into a sophisticated provider of primary health care services with 35 sites across Alameda, Contra Costa and Solano counties.

As a Billing Specialist, you will be responsible for the maintenance of a major portion of a complex billing operation; assuring that all information on claims submitted to payors is correct. You understand individual payors and work claim denials to assure that all claims are paid. You will thrive on the challenge of accepting ownership for accomplishing new and different tasks while exploring opportunities to add value to your job.

Major Areas of Responsibility include but are not limited to:

Claim Submission

• Maintain work operations for billing payers by following policies and procedures and identifying compliance issues
• Maintain quality results by following set standards for billing and collection procedures and activities.
• Perform general clerical duties as required. This role involves a considerable amount of computer work.

Claim Denial Management

• Work with Billers to make sure all information on claims is correct prior to submission.
• Audit the most complex patient claims for arithmetical accuracy, legibility, and compliance with program billing requirements.
• Understand complex reimbursement arrangements and is able to follow up with payors by working to assure that all claims are paid.
• Identify areas to improve claim submission data to reduce claim denials.
• Work to reduce Accounts Receivable by improving accuracy of claims and reducing claim denials.

Patient/Payer Statements & Collection

• Secure outstanding balance payments for care of patients by posting, adjusting, balancing, and sending regular statements.
• Collect delinquent accounts by establishing payment arrangements with patients/payors; monitoring payments; following up with patients when payment lapses occur.
• Respond to patient/payor questions about claims and resolves billing issues
• Protect the organization by keeping collection information confidential.

Minimum Job Requirements

Knowledge

• Knowledge of Health care third party reimbursement programs; such as Medicare, Medi-Cal, or private insurance.
• Knowledge of the methods, and practices of billing, accounts receivable, and collection.
• Knowledge of modern office methods and equipment.

Abilities

• Ability to prepare financial reports and maintain ledgers and journals.
• Ability to interpret billing policies and procedures for various programs.
• Ability to independently carry out varied responsible billing assignments.
• Ability to solve problems and resolve conflicts.
• Ability to work across cultures and demonstrate support of diversity, equity and inclusion.
• Ability to work across cultures and demonstrate support of diversity, equity and inclusion.

Other Certifications and Experience

• Requires high school diploma/equivalent
• Three years or more of full-time experience performing medical billing or medical accounts receivable functions.
• Excellent communication skills; must be able to work in a team environment
• Excellent customer service skills