Billing Specialist-Full-Time (M-F)-Billing Department Santa Rosa

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*Northern California Medical Associates is an Equal Opportunity Employer

JOB TITLE: Billing Specialist

GENERAL SUMMARY OF DUTIES: Responsible for all aspects of account follow up. Includes submission of appeals, responding to patient and health plan correspondence, telephone calls from offices, health plans, patients and physicians.

SUPERVISION RECEIVED: Reports to Director of Business Services or Department Manager


TYPICAL PHYSICAL DEMANDS: Requires prolonged sitting, some bending, stretching and occasional lifting of up to 25 pounds. Working in an office environment. Working under stress and use of telephone required. Requires manual dexterity to operate keyboard, calculator, copy machine and other office equipment. Requires eyesight correctable to 20/20 to read numbers, letters and computer monitor. Requires hearing within normal range for telephone use.

TYPICAL WORKING CONDITIONS: Normal office environment.

EXAMPLES OF DUTIES: (This list may not include all of the duties assigned.)

1. Submit claims to various payers either electronically or by paper.

2. Respond to correspondence from patients, staff, physicians and insurance companies.

3. Resolve patient billing questions and complaints.

4. Prepare, review and send patient statements.

5. Review accounts for possible assignment to collection agency.

6. Perform various collection actions including contacting patient by phone, correcting and resubmitting claims to payers.

7. Submit supporting documentation according to payer’s clinical policies.

8. Monitor open item aging to identify accounts with delinquent items requiring follow up.

9. Complete adjustments to remove non-payable services or correct erroneous entries.

10. Reconcile accounts.

11. Perform billing and charge corrections when identified.

12. Process requests for refunds.

13. Attend meetings as requested.

14. Participate in educational activities.

15. Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.

16. Perform related work as required.


Knowledge, Skills and Abilities:

Extensive knowledge of medical billing and collection practices including insurance company payment policies and fee schedules. Knowledge of medical office policies and procedures. Knowledge of CPT, ICD-9, and HCPCS coding. Knowledge of HIPAA guidelines. Knowledge of database functionality, Microsoft Word and Excel. Knowledge of basic accounting principles.

Skill in using computer, adding machine, and other office equipment. Ability to examine documents for accuracy and completeness. Ability to read, understand, and follow verbal and written instructions. Ability to establish and maintain effective working relationships with patients, employees and the public. Ability to communicate clearly both written and verbal. Skill in answering the telephone in a pleasant and helpful manner.

Education: High school diploma or GED

Experience: One year of billing experience in a health care organization.

Certificate/License: None


Additional appropriate education may be substituted for one year of billing experience.

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