Neighborhood Healthcare is seeking an Insurance Biller for denials. Full time positions (40 hours per week). Prior insurance billing experience is required. Bilingual: english/spanish preferred.
**Please send resumes to MelanieS@nhcare.org, or fax to (760) 796-4021, “Attn: Insurance Biller-Denials”**
Under the direction of the Billing Supervisor, the Denials Specialist is responsible for all payments, denials, appeals, and manual billing for patients and third parties, to include Medi-Cal, CHDP, Medicare, CMS, private insurance, Family Planning, and various other programs. Responsible for correct coding implementation and compliance with procedures set by the department. Position also entails credentialing of licensed medical providers.
Duties and Responsibilities Include:
Posting of payments and account balance adjustments.
Review and working of aging reports for assigned payor sources to include rebills/tracers, corrected claims, submission of medical records, patient eligibility issues, etc.
Printing and review of paper claim submissions for clean claim status prior to mailing.
Download of RA information for processing.
Processing and account review of all incoming EOBs and denials
. Responsible for providing coding updates, benefit changes, denial trends, data entry error trends to the Insurance Billers, Providers, Site Managers, sites, etc. (as appropriate).
Review of payment/denial trends.
Monitor contractual allowances with payments and claim submissions to assure appropriate payments are made.
Discusses billing questions with patients and handle inquiries from third parties.
Adjust patient accounts and resolve account questions as needed.
Assist in maintaining an orderly filing system for all processes in the department as well as maintaining compliance standards.
Attend billing and Healthpro workshops as required.
Attend staff meetings and clinic in-services.
Assist other Insurance Billers as directed by department needs and work flow.
Site training and in-servicing on benefit and coding issues as needed.
Credentialing of licensed medical providers. Other duties as assigned (may include monthly invoicing and/or calendar/fiscal year projects as needed by various payer sources)..
Qualifications:
Attention to detail and accuracy; motivated self-starter; billing and denial experience required. Enthusiastic, ability to work efficiently in a fast paced environment. Excellent customer service skills required. Bilingual (English/Spanish) preferred.