Medical Billing Coordinator

This is a fully remote position, open to applicants in California.

📋 Description

• Perform prompt and accurate follow-up on professional services claims utilizing payor portals, secure chat, secure messaging, and phone calls.

• Detect missing payments from health plans and initiate tracking protocols.

• Assess incoming correspondence from health plans and take necessary actions or elevate issues as needed.

• Locate pending claims and ascertain next steps to secure reimbursement.

• Analyze a limited number of new denials for processing errors, assign status, rectify internal mistakes, and resubmit claims as required.

• Follow up with insurance carriers, providers, and other relevant parties to collect information or documentation essential for claims resolution.

• Monitor provider messages and either respond or escalate requests accordingly.

• Recognize complex claims issues and escalate them for resolution.

• Investigate health-plan reimbursement policies, procedures, clinical guidelines, coding, and CCI edits.

• Interact with insurance companies, healthcare providers, and billing personnel to resolve claims issues and address inquiries.

• Record interactions, claim status, actions taken, and resolutions in claims management systems.

• Prepare and submit reports regarding claim follow-up activities and status updates to management.

• Ensure that claims follow-up adheres to company policies, industry regulations, and legal standards.

• Remain informed about insurance policies, regulations, and industry standards.

• Attend departmental and company meetings as necessary.

• Identify and report trends that negatively impact claim payments.

• Investigate and resolve discrepancies in claims processing and payments.

• Collaborate with team members and various departments to ensure accurate claim submission.

• Recognize and propose process enhancements.

• Engage in training and development opportunities.

⛳️ Requirements

• At least 3 years of experience as a medical biller or in a similar capacity.

• Outstanding technical skills, including the ability to work with multiple systems simultaneously and quickly learn new systems.

• EZ-Cap experience is preferred.

• Experience with Electronic Data Interchange (EDI) Clearinghouse (Office Ally) is preferred.

• Proficiency in Microsoft Suite: Outlook, Teams, Office365, OneNote, OneDrive, SharePoint.

• Familiarity with Sequel Server Management Studio.

• Knowledge of Confluence.

• Understanding of Azure.

• In-depth knowledge of healthcare benefits, network participation, coordination of benefits, referral, and authorization requirements, as well as insurance follow-up.

• Working knowledge of CPT Codes, ICD-10 Codes, Modifiers, MUE, LCD, NCD, and CCI edits.

• Strong skills in time management, multitasking, critical thinking, attention to detail, and organization.

• Ability to thrive in a fast-paced environment while upholding strict confidentiality.

• Excellent written and verbal communication abilities.

• Must achieve a quantitative production standard of processing 100–150 claims per week.

🏝️ Benefits

• 100% employer-funded medical, vision, dental, and life insurance coverage.

• Paid holidays, sick leave, and vacation time.

• 401(k) retirement plan.

• Additional employee-funded coverage options.

• Fully remote work setting.

• Flexible work environment and scheduling options.