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Robert Half Billing Clerk in Long Beach, California

Description

The Billing Specialist ensures accuracy and compliance for professional billing via insurance claims and patient statements at our client in the medical research industry. This role works directly with patients, insurance companies, financial counselors, scheduling, business office, and clinical departments to ensure all records are up-to-date, compliant with billing and coding guidelines, and consistent. This individual is responsible for resolving claim edits, resolving clearinghouse rejections and coding discrepancies, and balance variances via the PM system(s). The Medical Billing Specialist will demonstrate knowledge in all areas of the medical billing process and will serve as the billing and coding expert for the organization.

Duties and Responsibilities:

Medical Billing:

  • The specialist is responsible for the timely submission of professional medical claims to various payors.

  • Prepare, review, and transmit claims for electronic and/or paper claim submission from the PM system.

  • Responsible for resolving claim edits and clearinghouse rejections via the PM system.

  • Responsible for processing all secondary claims via electronic and/or paper claim submission.

  • Responsible for submitting claims with required documents, per payor guidelines or as requested (i.e., medical records).

  • Review patient statements for accuracy and completeness prior to billing.

  • Maintain a current understanding of local coverage determinations, payor and coding guidelines to ensure claims are consistently billed properly.

  • Perform charge reconciliation from the daily appointment schedule.

  • Perform posting of charges, electronic and/or manual to the PM system.

  • Keep abreast with medical coding updates and educate team members of changes in a timely manner.

  • The specialist will maintain confidentiality and is knowledgeable of AMA CPT, HCPCS, and ICD codes and HIPPA guidelines.

  • Ensure patient and insurance demographics is accurate.

  • Enter and make the appropriate changes in the EMR/PM system(s) and Salesforce regarding insurance and eligibility, and insurance information, as needed.

  • Respond to email and phone calls related to billing and claim submissions.

  • Verify eligibility and benefits using a real-time system response, through health plan portals, and/or via telephone to the health plan and/or guarantor.

  • Ensure appropriate authorization or referral numbers are on the claim prior to submission.

  • Performs job duties with oversight.

  • Other duties as assigned.

    Requirements

Qualifications:

  • High School diploma or equivalent required

  • Customer Service experience required

  • 3+ years of experience in medical billing strongly preferred

  • 3+ years of experience in a specialty group practice preferred

  • Comfortable navigating across various computer systems to locate critical information.

  • Medical billing and coding certification preferred.

  • Knowledge of insurance policies/guidelines, EOB (Explanation of Benefits), prior authorization/referral processes, medical terminology, CPT/ICD/HCPCS coding preferred.

  • Experience with a CMS-1500 claim form.

  • Experience working with clearinghouses for the purpose of claim submissions.

  • Experience with payor portals and affiliates.

  • Experience with EMR and PM systems (Athena, AdvancedMD a plus)

  • Experience using Salesforce a plus

  • Must have strong analytical skills, proficient with spreadsheets

  • Knowledge of health networks, IPA, HMO, PPO and contract affiliations.

  • Exceptional organizational, presentation, and communication skills, both verbal and written.

  • Proficiency in meeting deadlines and prioritize workload.

  • Ability to work independently, with direction, and as part of a team.

  • Experience with Microsoft Office Suite

  • Self-motivated, team-oriented, very responsible, and focused on exceeding customer expectations.

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half puts you in the best position to succeed by advocating on your behalf and promoting you to employers. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity – even on the go. Download the Robert Half app (https://www.roberthalf.com/mobile) and get 1-tap apply, instant notifications for AI-matched jobs, and more.

Questions? Call your local office at 1.888.490.3195. Robert Half will consider qualified applicants with criminal histories in a manner consistent with the requirements of the San Francisco Fair Chance Ordinance. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to temporary professionals. Visit https://roberthalf.gobenefits.net/ for more information.

© 2022 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/terms-of-use) .

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