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*Northern California Medical Associates is an Equal Opportunity Employer
Position Title: Payments and EDI Coordinator
Reports To: Director of Business Services
FLSA Status: Non-Exempt
Location: Santa Rosa, CA
Schedule: Full-Time, Monday – Friday, 8:00am to 4:30pm
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.
• Prepare, batch and mail paper claims. Assist Support Staff if needed.
• Responsible for signing in and security of bank bags containing deposits. Verifies amount received balances to proof.
• 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.
• Entry of monthly charges and receipts for medical records.
• Understand and implement organizational policies and procedures.
• Help staff establish deadlines for work assignment and completion. Monitor work status and progress.
• Assist in training and development of staff.
• This position has no direct supervisory responsibilities.
Education, Licensure and/or Certifications
• High school diploma or GED
• One year of billing experience in a health care organization.
Knowledge, Skills and Abilities
• 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.
• Knowledge of HIPAA guidelines.
• 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 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.