Medical Biller II

Job Description

Job Description

MISSION, VISION, AND VALUES

Our mission is to provide quality, comprehensive healthcare and supportive services to our community. Our vision is “Improving the Health and Well-Being of Our Community.” Our core values are Integrity, Compassion, and Excellence. Employees are expected to demonstrate a strong commitment to the mission, policies, goals, and philosophy of Harbor Community Health Centers.

JOB SUMMARY

Reporting to the Revenue Cycle Manager (RCM), the Medical Biller II is responsible for the billing and collection activities for the clinic’s primary care, pediatric, behavioral health, and dental services. This position works closely with providers, Front Office staff, and the Quality Improvement Department.

ESSENTIAL DUTIES & RESPONSIBILITIES  

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

An individual must be able to perform each essential duty satisfactorily to be successful in this role. The requirements below represent the knowledge, skills, and abilities needed for the position.

Insurance Verification and Claim Scrubbing:

1. Reviews insurance information, financial classification, and eligibility for all claims prior to submission. 
2. Understands insurance billing requirements, including Medi-Cal, Newborn Gateway, CPE, PE4PP, Family PACT, Medicare, commercial insurance plans, and various dental programs.
3. Understands the application of the Sliding Fee Discount Program, documents and reviews discrepancies with RCM to develop a correction plan for improvement.
4. Ensures that all conditions for claim submission have been satisfied, including but not limited to: accurate charges and financial class, authorization/certification information, demographic and insurance information.

Claims Submissions

1. Ensures complete filing and follow-up of encounter data submissions to health plans, IPAs, and other payers, including secondary and crossover billing.
2. Submits all claims, electronically or via paper forms (IHCFA 1500/UB04) to various payers in a timely manner.

Communication: 

1. Monitors, tracks, and communicates with providers to ensure progress notes are closed in a timely manner. 
2. Responds professionally to billing inquiries from patients, payers, providers, and staff.
3. Tracks discrepancies in front office operations and provides feedback and recommendations for process improvements based on findings.

Patient Statements & Collections: 

1. Thoroughly analyzes patient accounts to ensure patient balances are accurate.
2. Generates and submits patient statements monthly.
3. Reconciles and audits daily patient payment collections and ensures that sufficient change is available for patient transactions. 

Payment Posting and A/R Reconciliation

1. Posts and reconciles payments, charges, and adjustments to patient accounts.

Denials & Follow-Up 

1. Ensures that all denials are corrected, rebilled or adjusted in a timely manner.
2. Interprets and reviews insurance EOBs, determines claim denial reasons and follows up with corrections and appropriate actions.

Collaboration and Compliance 

1. Ensures compliance with HIPAA and payer-specific guidelines.
2. Assists with month-end billing close activities within 10 business days following month-end.
3. Participates in training and professional development opportunities to maintain up-to-date knowledge.
4. Works closely with Front Office staff (Patient Experience Specialists) on various projects.
5. Performs other duties as assigned.

QUALIFICATIONS 

Experience:

• Must have at least 2–3 years of direct medical billing experience (FQHC experience strongly preferred).
• Experience with an electronic health record (EHR) system required; eClinicalWorks experience preferred.

Skills and Attributes: 

1. Understands CPT, CDT, HCPCS, and ICD-10 coding protocols, as well as Medi-Cal, Medicare, managed care, and private insurance requirements related to FQHC billing.
2. Must be bilingual and fluent in English and Spanish.
3. Must demonstrate good attendance and punctuality and complete all assignments timely.   
4. Must have proficient computer skills, including Microsoft Office abilities, with intermediate Excel skills.
5. Must have a high level of accuracy, excellent analytical, problem solving and time management skills, and possess strong organizational skills.
6. Ability to adapt to changes in the clinic setting and insurance payer requirements.
7. Communicate effectively with providers, other staff, and outside vendors.
8. Work collaboratively in a team environment, have excellent writing skills and be able to prioritize effectively.
9. Must maintain confidentiality and handle sensitive information with discretion
10. Must have the willingness and ability to adapt to change, including advances in technology.

Preferred Education, Experience, and/or Training:

High school diploma or GED required. Certified Professional Coder and/or Certified Professional Biller preferred.

EXPECTATIONS

• Adheres to all HarborCHC policies and procedures. 
• Demonstrates HarborCHC’s core values of Integrity, Compassion, and Excellence at all times. 
• Maintains a strong commitment to the mission, policies, goals, and philosophy of HarborCHC. 
• Maintains a positive and respectful attitude in all work-related interactions. 
• Communicates regularly with their immediate supervisor regarding departmental and organizational matters. 
• Reports to work consistently and prepared to perform the duties of the position. 
• Meets productivity standards and performs duties as workload requires. 
• Maintains strict confidentiality of all data and information. 
• Demonstrates integrity and accountability in all duties and responsibilities. 
• Performs all job functions in a professional and courteous manner, including responding to phone calls and emails in a timely manner.

PHYSICAL REQUIREMENTS

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. While performing the duties of this job, the employee is regularly required to sit; use hands to manipulate objects, tools or controls; reach with hands and arms; and talk and hear. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust.

HOURS OF OPERATIONS

HarborCHC is open Monday-Thursday 7:00am-7:00pm, Friday 8:00 am-5:00pm, and Saturday 8:00am-5:00pm.

HR PROCEDURAL REQUIREMENTS

• Must be legally authorized to work in the United States
• Must successfully complete post-offer background screening and verification requirements
• This job description is not intended to be all-inclusive; additional duties may be assigned

EQUAL EMPLOYMENT OPPORTUNITY STATEMENT

HarborCHC does not discriminate in employment opportunities or practices on the basis of race; religion; color; sex/gender (including pregnancy, childbirth, breastfeeding or related medical conditions); sexual orientation; national origin; ancestry; physical or mental disability; medical condition; genetic information/characteristics ; marital status/registered domestic partner status; age; sexual orientation; reproductive health decision-making; military or veteran status; use of cannabis off the job and away from the workplace; and any other basis protected by federal, state or local law or ordinance or regulation, or any other legally recognized protected basis under federal, state or local laws, regulations or ordinances. This policy applies whether the individual has or is perceived to have any of the characteristics protected by law or is associated with a person who has or is perceived to have any of the characteristics protected by law. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, and transfer, leaves of absence, compensation, and training.

DISCLAIMER

The above statements define this position as it currently exists and are intended to describe the general responsibilities and requirements for this job. They are not to be considered as an exhaustive statement of duties, responsibilities, or requirements and does not limit the assignment of additional duties at the discretion of the supervisor. HarborCHC is an at-will employer.

In addition, HarborCHC may change your duties, compensation or hours, or transfer, reassign, promote, demote, suspend, or otherwise change the terms and conditions of your employment (other than the at-will relationship), with or without cause or prior notice.

Mon - Fri 8:00 am to 5:00 pm