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  independently performs billing, claims submission, payment posting, denial resolution, accounts receivable follow-up, and account reconciliation activities for HarborCHC’s primary care, pediatric, behavioral health, and dental services. This position works collaboratively with providers, Patient Experience staff, and other departments to support accurate and timely reimbursement, resolve complex billing issues, and identify opportunities for revenue cycle process improvement.

ESSENTIAL DUTIES & RESPONSIBILITIES

Reasonable accommodation 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:

• Reviews insurance information, financial classification, and eligibility for all claims prior to submission.
• Applies payer-specific billing requirements, including Medi-Cal, Newborn Gateway, CPE, PE4PP, Medicare, commercial insurance plans, and applicable dental programs.
• Applies Sliding Fee Discount Program requirements, documents discrepancies, and reviews findings with the RCM to support corrective action and process improvement.
• Ensures that all conditions for claim submission have been satisfied, including but not limited to accurate charges and financial class, authorization/certification information, and demographic and insurance information.

Claims Submissions

• Ensures complete filing and follow-up of encounter data submissions to health plans, IPAs, and other payers, including secondary and crossover billing.
• Submits claims electronically or via applicable paper claim forms, including CMS-1500 and UB-04, as applicable, to payers in a timely manner.

Communication:

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

Patient Statements & Collections:

• Thoroughly analyzes patient accounts to ensure patient balances are accurate.
• Generates and submits patient statements monthly.
• Reconciles and audits patient payment activity and identifies and reports discrepancies in accordance with established cash-handling and reconciliation procedures.

Payment Posting and A/R Reconciliation

• Posts and reconciles payments, contractual adjustments, denials, and other account activity accurately and timely. 
• Reviews outstanding accounts receivable and performs appropriate payer follow-up to facilitate timely resolution and reimbursement. 
• Identifies payment discrepancies, underpayments, and unresolved account balances and takes appropriate follow-up action.

Denials & Follow-Up

• Reviews and resolves claim denials and rejections, determines appropriate corrective action, and completes timely follow-up through resolution.
• Reviews EOBs and other payer correspondence to identify denial and payment issues; submits corrected claims, reconsiderations, or appeals as appropriate; and identifies recurring denial trends for communication to the RCM.

Collaboration and Compliance

• Ensures compliance with HIPAA and payer-specific guidelines.
• Assists with month-end billing close activities within 10 business days following month-end.
• Participates in training and professional development opportunities to maintain up-to-date knowledge.
• Works closely with Front Office staff (Patient Experience Specialists) on various projects.
• 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:

• Reviews claims to verify that applicable ICD-10 and CPT/HCPCS codes are present prior to submission; does not assign, select, or determine diagnosis or procedure codes. Maintains working knowledge of Medi-Cal, Medicare, managed care, commercial insurance, and FQHC billing requirements.
• Must be bilingual and fluent in English and Spanish.
• Must demonstrate good attendance and punctuality and complete all assignments in a timely manner.
• Must have proficient computer skills, including Microsoft Office, with intermediate Excel skills.
• Must demonstrate a high level of accuracy and possess strong analytical, problem-solving, time-management, and organizational skills.
• Ability to adapt to changes in the clinic setting and insurance payer requirements.
• Communicates effectively with providers, staff, and outside vendors.
• Works collaboratively in a team environment, demonstrates strong written communication skills, and prioritizes work effectively.
• Must maintain confidentiality and handle sensitive information with discretion.
• Must demonstrate willingness and ability to adapt to change, including advances in technology.

Education and Preferred Credentials:

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

EXPECTATIONS

• Adheres to all HarborCHC policies, procedures, and applicable organizational standards.
• Demonstrates HarborCHC's core values of Integrity, Compassion, and Excellence and maintains a strong commitment to HarborCHC's mission and goals.
• Maintains a positive, professional, and respectful approach in all work-related interactions.
• Communicates regularly and effectively with their immediate supervisor regarding departmental and organizational matters.
• Maintains regular and reliable attendance and reports to work prepared to perform the duties of the position.
• Meets established productivity, quality, and timeliness expectations and performs duties as workload requires.
• Maintains strict confidentiality and handles sensitive information with discretion.
• Demonstrates accountability and professionalism in carrying out assigned duties and responsibilities.
• Responds to work-related communications, including phone calls and emails, in a timely and professional 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 position. While performing the duties of this job, the employee is regularly required to sit for extended periods; use a computer, keyboard, mouse, telephone, and other standard office equipment; and communicate effectively with others. The employee may occasionally be required to stand, walk, reach, bend, and lift or move items weighing up to 25 pounds. The position requires the visual ability necessary to perform computer-based work and review electronic and written information. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

HOURS OF OPERATIONS

HarborCHC's hours of operation are

• Monday–Thursday: 7:00 a.m.–7:00 p.m.
• Friday & Saturday: 8:00 a.m.–5:00 p.m.

Employee work schedules may vary based on departmental and operational needs.

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 is an equal opportunity employer and is committed to providing employment opportunities without discrimination on the basis of race, color, religion, sex, gender, gender identity, gender expression, pregnancy, childbirth, breastfeeding or related medical conditions, sexual orientation, national origin, ancestry, age, physical or mental disability, medical condition, genetic information or characteristics, marital status, registered domestic partner status, reproductive health decision-making, military or veteran status, or any other characteristic protected by applicable federal, state, or local law.

This policy applies to all terms and conditions of employment, including recruitment, hiring, placement, promotion, compensation, training, transfer, leaves of absence, discipline, termination, layoff, and recall.

DISCLAIMER

The above statements describe the general responsibilities and requirements of this position and are not intended to be an exhaustive list of all duties, responsibilities, or requirements. HarborCHC reserves the right to assign additional duties and modify job responsibilities based on operational needs. Employment with HarborCHC is at will. HarborCHC may change an employee's duties, compensation, hours, or other terms and conditions of employment, or transfer, reassign, promote, demote, or suspend an employee, with or without cause or prior notice, subject to applicable law. Nothing in this job description alters the at-will employment relationship.

​Monday–Thursday: 7:00 a.m.–7:00 p.m.
Friday & Saturday: 8:00 a.m.–5:00 p.m.
Employee work schedules may vary based on departmental and operational needs.