Senior Insurance Billing Clerk - Patient Accounting-Billing

Senior Insurance Billing Clerk

The County of Riverside - Riverside University Health System (RUHS) - Medical Center is seeking a Senior Insurance Billing Clerk in Riverside. Under general supervision, the incumbent will be responsible for reviewing and making follow-up determinations on denied claims while performing complex account resolution, leading and training staff, serving as a trusted resource in navigating challenging problems related to procedures, regulations, and complex accounts, drafting original correspondence, dispute letters, and appeals to payorsspecifically for facility (hospital) billing and special programsand providing exceptional customer service support to both internal and external clients, interpreting and explaining regulations, contractual language, and legal obligations, monitoring accounts for payment, and recommending solutions for delinquent accounts, reviewing patient insurance forms for accuracy, contacting patients and insurance companies to obtain treatment authorizations and verify eligibility, responding to requests for account information, and initiating calls to patients, insurers, and internal or external departments regarding billing and follow-up matters; leading and performing specialized and more difficult fiscal clerical work in connection with processing and billing fiscal intermediaries for medical services rendered to patients; and to do other work as required.

The most competitive candidate will have professional experience and knowledge with/of the following: - Possess a medical billing certificate - At least 3 years of medical billing and/or collections, specifically in a hospital setting - Epic - Ability to review and interpret payor contracts - Knowledge of diverse payor mix - Medi-Cal, Medicare, Managed Care, Commercial and other Government payors - Bilingual The ideal candidate will also be detail and goal oriented and have good verbal and written communication skills. Work schedule: 9/80 schedule with every other Friday off: Monday Thursday 7:30am 4:30pm and working Friday from 7:30am -3:30pm

Founded in 1893, Riverside University Health System Medical Center has grown into a cornerstone of healthcare excellence and medical education in the region. Our highly skilled healthcare professionals and dedicated support staff are committed to delivering exceptional, state-of-the-art care to the diverse populations of Riverside County.

Located in Moreno Valley, our 439-bed Medical Center is home to a Level I Trauma Center, a Level II Pediatric Trauma Center, and the county's only Pediatric Intensive Care Unit (PICU). If you're passionate about making a meaningful difference and helping others, RUHS Medical Center is the place for you!

For more information about RUHS Medical Center, please visit

Leads and trains staff; Serves as a resource for staff in the solution of difficult problems relating to procedures and regulations; Assists staff in resolving a variety of difficult problems. Checks and corrects bills and accounts for numerical accuracy, proper coding and prepares ATP's for data entry. Reviews patient accounts to determine the accuracy of account information and makes any required adjustments for proper billing purposes. Registers patients for medical services such as emergency treatment care and non-emergency walk-in treatment. Verifies billing account or insurance forms for completeness and accuracy against a variety of automated and manual records.

Two years experience performing fiscal, statistical and fiscal record keeping functions with at least one year involving third party intermediary medical billing. Knowledge of: Methods and terminology of financial and statistical clerical work including knowledge of general clerical auditing and verification techniques; General billing, medical terminology, and billing forms with knowledge of the application of computerized accounting systems. Ability to: Lead staff; Understand and apply rules and regulations pertaining to medical billing policies and procedures while identifying routine billing errors and differentiate between appropriate applications of various billing methods; Perform basic mathematical computations rapidly and accurately; Organize work to meet prescribed deadlines.

Application Status How to confirm your application was received or check on the status of your application, log-in to click on your name in the upper right corner, and click on "Applications & Status". Sign Up for Job Alerts Go to click on "Careers", click on "County Job Openings", and click on "Subscribe to Job Alerts" icon. For questions regarding this recruitment: Contact Raven Padilla at View email address on click.appcast.io or View phone number on click.appcast.io. Please allow 1-2 business days for response to general inquires.

A choice of different medical, dental and visions plan are available to elect. The County provides a Flexible Benefit Credit contribution as governed by the applicable LIUNA Memorandum of Understanding to contribute towards the cost of these plans. Note: Employees on assignment through the Temporary Assignment Program (TAP) receive different benefits. See the list here.

County of Riverside has three retirement Tiers through the California Public Employees' Retirement System (CalPERS).

• Tier I (Classic Member Formula 3% @ 60): Applicable to current and former County of Riverside local miscellaneous employees hired prior to 08/24/2012 and did not withdraw CalPERS contributions. The employee contribution is eight (8%) percent.
• Tier II (Classic Member Formula 2% @ 60): Applicable to local miscellaneous employees 1) hired after 08/23/2012 through 12/31/2012; 2) Previously employed with another CalPERS contracting public agency or a reciprocal retirement system, with a break in service of less than six months between the separation date with the previous employer and the appointment date with the County of Riverside. The employee contribution is seven (7%) percent.
• Tier III (PEPRA New Member - Formula 2% @ 62): Applicable to CalPERS local miscellaneous new members hired on or after the implementation of the Public Employees' Pension Reform Act of 2013 (PEPRA) which took effect January 1, 2013. Effective July 1, 2023 employee contributions are 7.25% and will increase to 7.75% effective July 1, 2024.

A new member is defined as any of the following:

1. A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who has no prior membership in any California Public Retirement System.
2. A new hire who enters CalPERS membership for the first time on or after January 1, 2013, and who was a member with another California Public Retirement System prior to that date, but who is not subject to reciprocity upon joining CalPERS.
3. A member who first established CalPERS membership prior to January 1, 2013, and who is rehired by a different CalPERS agency after a break in service of greater than six (6) months.

CalPERS refers to all members that do not fit within the definition of a new member as "classic members".

Contribution rates are subject to change based on the County of Riverside annual actuarial valuation.

This summary is for general information purposes only. Additional questions regarding retirement formulas can be sent to View email address on click.appcast.io or by calling the Benefits Information Line at View phone number on click.appcast.io, Option 2.

If you have prior service credit with another CalPERS agency or within agencies, please contact CalPERS at View phone number on click.appcast.io to determine which retirement tier would be applicable to you. CalPERS is governed by the Public Employees' Retirement Law. The Retirement Law is complex and subject to change. If there's any conflict between this summary and the law, the law will prevail over this summary.

Voluntary employee contribution with a choice between two 457 deferred compensation plan options. VACATION ACCRUAL (Bi-Weekly Accrual): 0 < 3 year = 80 Hours (10 Days) 4 < 9 years = 120 Hours (15 Days) 10 or more years = 160 Hours (20 Days) Maximum Vacation leave accumulation is 480 hours. SICK LEAVE: Four (4) hours Sick Leave accrual per pay period with unlimited accrual. HOLIDAYS: Normally 12 paid holidays per year BEREAVEMENT LEAVE: Allowed 5 days (3 days are County paid; 2 additional days can be taken from accrued Sick Leave balance) BASIC LIFE INSURANCE: Equal to one times annual base salary not to exceed $50,000 of term life coverage. Premiums are paid by the County. Additional Supplemental Life plan is available for employee purchase. DISABILITY: Employees contribute to State Disability Insurance (SDI), which provides wage replacement benefits for those unable to work due to non-work-related illness, injury, or pregnancy. SDI also includes Paid Family Leave benefits. The wage replacement rate, as defined by current law, is between 60-70% of wages earned during the SDI eligibility period. Benefits can be coordinated with other available leave balances to provide up