Medical Billing Coordinator

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

📋 Description

• Performs timely and precise follow-up on professional services claims to guarantee that all required information has been submitted and claims are processed via payor portals, secure chat, secure messaging, and telephone communications.

• Detects unreceived payments from health plans and initiates tracking measures.

• Assesses incoming correspondence from health plans and takes suitable action or escalates to designated team members as necessary.

• Identifies pending claims and determines the necessary next steps to secure reimbursement for those claims.

• Utilizes existing queries to examine limited new denials for processing errors, appropriately assigns a status based on the review, rectifies any internal errors, and resubmits claims as required.

• Engages with insurance carriers, providers, or other stakeholders to collect additional information or documentation needed for claims resolution.

• Monitors incoming messages from providers and replies to the provider or escalates the request to the relevant team member.

• Recognizes claims with more intricate issues and escalates them to the appropriate team member for resolution as necessary.

• Investigates health plan reimbursement policies and procedures, clinical guidelines, coding, and CCI edits to ensure claims are billed correctly.

• Effectively communicates with insurance companies, healthcare providers, and their billing staff to resolve claims issues and address inquiries.

• Records all interactions and updates in the claims management system.

• Maintains accurate documentation of claim status, actions taken, and resolutions by utilizing established policies and procedures.

• Prepares and submits reports on claim follow-up activities and status updates to management as requested.

• Ensures that all claims follow-up activities comply with company policies, industry regulations, and legal requirements.

• Remains informed of changes in insurance policies, regulations, and industry standards.

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

• Attends departmental and company meetings as required.

• Identifies and reports trends that could negatively affect claim payments, such as processing errors, denials, or billing issues.

• Investigates and resolves discrepancies or issues related to claims processing and payment.

• Collaborates with other team members and departments to ensure proper claim submission.

• Identifies and suggests process improvements to enhance the efficiency and effectiveness of the claims follow-up process.

• Participates in training and development opportunities to stay updated with best practices and industry trends.

⛳️ Requirements

• A minimum of 3 years of experience as a medical biller or in a similar role.

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

• EZ-Cap experience is preferred.

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

• Proficient in Microsoft Suite – Outlook, Teams, Office 365, OneNote, OneDrive, SharePoint.

• Familiarity with Sequel Server Management Studio.

• Knowledge of Confluence and Azure.

• Comprehensive understanding of healthcare benefits, network participation, coordination of benefits, referral and authorization requirements, and insurance follow-up.

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

• Must exhibit strong time management skills, the ability to multitask, resolve issues using critical thinking, and possess a detail-oriented and highly organized approach.

• Capability to work in a fast-paced environment while maintaining strict confidentiality.

• Excellent written and verbal communication skills.

🏝️ Benefits

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

• Paid holidays.

• Paid sick time.

• Paid vacation time.

• 401(k) plan.

• Additional employee-paid coverage options available.