Payments and EDI Coordinator – Full-Time – Billing Department

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*Northern California Medical Associates is an Equal Opportunity Employer


Position Title: Payments and EDI Coordinator
Clinic: Billing Department
Location: Santa Rosa, CA
Schedule: Full-Time, Monday-Friday

Summary: Coordinate all aspects of payment entry, bank deposits, balancing payment entry to bank deposit, claim submission (electronic and paper), electronic data interchange (EDI) processes and mail.

Duties and Responsibilities (includes, but is not limited to the following):
• Primary resource for Payment Unit staff by assisting with questions and day-to-day workflow.
• Enroll providers and/or offices for electronic claims submission and electronic remittances.
• Update master files in practice management system as necessary.
• Generate claims (electronic and paper) on daily basis and monitor submission.
• Contact practice management or revenue cycle management company regarding issues involving the system and work with them on resolution.
• Prepare, batch and mail paper claims. Assist support staff if needed.
• Distribute error reports and reassign errors/rejections received in revenue cycle manager to appropriate party.
• Responsible for signing in and security of bank bags containing deposits. Verifies amount received balances to proof.
• Prepare bank deposit for cash receipts and take to bank if support staff unavailable.
• Entry of payment batches.
• Ensure all payments and EOBs received are accurately posted and balance to bank deposits for month.
• Reconcile office deposit discrepancies with office manager/coordinator.
• Posting of daily charge, payment and adjustment batches.
• Maintain payment logs for each A/R.
• Complete and distribute reports including Daily Totals and Production Analysis.
• Entry of monthly charges and receipts for medical records.
• Oversee sorting and distribution of mail, both USPS and interoffice. Assist support staff if needed.
• Develop guidelines for prioritizing work activities, evaluating effectiveness and modifying activities as necessary.
• Help staff establish deadlines for work assignment and completion. Monitor work status and progress.
• Identify, analyze and resolve work problems.
• Assist in training and development of staff.
• Ensure requests for information are handled promptly and effectively.

Education, Licensure and/or Certifications
• High school diploma or GED

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

Knowledge, Skills and Abilities
• Knowledge of fiscal management and human resources management techniques.
• Knowledge of office management techniques and practices.
• Maintains a thorough understanding of health care patient systems, including fee schedules, capitated and managed care contracting issues, etc.
• Knowledge of applying insurance, Medicare, Medi-Cal, Worker’s Comp., etc. payments according to explanation of benefits.
• Knowledge of contracted reimbursement rates.
• Knowledge of medical office procedures, ICD-9, ICD-10, CPT, HCPCS coding and insurance company operating procedures.
• Extensive knowledge of database functionality including Microsoft Word and Excel.
• Knowledge of accounting principles.
• Skill in gathering, analyzing and evaluating data.
• 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 manage and maintain effective working relationships with assigned staff, other employees, patients, physicians, organizations and the public.
• Ability to communicate clearly both written and verbal.
• Ability to convey reimbursement knowledge to staff, patients and physicians.

Physical Demands: The physical demands described here are representative of those that may need to be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Requires prolonged sitting, some bending, stretching and occasional lifting of up to 25 pounds.
• 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.

Work Environment: The work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The work environment consists of a normal office environment. Occasional evening or weekend work may be needed.