Job Title: Billing Specialist I

Position Summary:
The Billing Specialist I plays a crucial role in maintaining the billing systems, ensuring accurate and timely billing processes. This position reports to the Revenue Cycle Director and involves various responsibilities related to patient billing, insurance claims, and financial documentation.

Minimum Requirements:

• High school diploma or GED, along with one year of billing experience or a billing certificate (preferred but not required).
• Experience in a clinic, hospital, or Federally Qualified Health Center setting is preferred.
• Proficiency in 10-key and typing skills (minimum 35 wpm), with a typing certificate required.
• Familiarity with computerized medical or dental billing systems is preferred.
• Bilingual candidates in Spanish and English are highly preferred.
• Valid California Driver's license, proof of insurance, and personal transportation are required.

Specific Duties:

• Maintain billing for all patients, including charges, payments, adjustments, and follow-ups for Self-Pay, Medi-Cal, Medicare, and third-party payers.
• Review patient documentation to ensure correct coding and accurate billing.
• Analyze patient medical records to determine billable services based on payer guidelines.
• Evaluate pending charges for accuracy, including dates of service, procedure codes, and modifiers.
• Ensure timely charge submission through electronic EHR charge capture.
• Conduct initial claim scrubs before billing using practice management software.
• Import electronic payments from third-party payers.
• Perform quality control on data entry to verify accuracy in payment posting.
• Run reports to monitor unpaid claims and collect outstanding balances.
• Identify billing errors and follow up on rejected claims with supervisors.
• Verify eligibility for various third-party payers.
• Address inquiries from patients and staff regarding billing and charges.
• Write off credit balances as appropriate and compare insurance files for discrepancies.
• Provide requested information for patient subpoenas as needed.
• Collaborate with Center Managers and clinical staff on charge acceptance corrections.
• Perform additional duties as assigned.

Performance Requirements:

• Knowledge of billing practices, clinic policies, and coding systems.
• Ability to utilize Electronic Health Records and Practice Management systems.
• Proficiency in Excel and Microsoft Word.
• Strong skills in document examination for accuracy and completeness.
• Excellent verbal and written communication skills.
• Ability to provide exceptional customer service, demonstrating empathy and understanding in all interactions.
• Strong listening skills and a willingness to meet the needs of patients and colleagues.

Typical Physical Demands:

• Requires sitting for extended periods and working in an office environment.
• Involves some bending, stretching, and manual dexterity for using a calculator and computer keyboard.
• May require working under stress and frequent use of a telephone.

Typical Working Conditions:

• Normal office environment.

This position offers an opportunity to contribute to a vital aspect of healthcare billing and revenue cycle management while providing essential support to patients and healthcare providers.