Medical Biller II Job San Pedro California USA,Healthcare

Location: San Pedro

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…