Summary:
Applicant must possess a high school diploma or equivalent. A diploma in Medical Coding and Billing is preferred. Certification as a Certified Professional Biller (CPB) is required. Applicant must have a minimum of two years of experience billing Medicare, Medi-Cal, and Managed Care Plans, including IEHP, Molina, Blue Shield, and Kaiser, as well as FQHC encounter billing. A minimum of two years of experience with medical terminology, ICD-10-CM diagnosis, CPT procedures, and HCPCS codes is required. two years of experience in customer service and medical billing and experience using NextGen Practice Management, Waystar Clearinghouse, and electronic remittance systems is preferred. Two years of experience in customer service and medical billing, as well as experience using NextGen Practice Management, Waystar Clearinghouse, and electronic remittance systems, is preferred. Knowledgeable in insurance billing requirements, including Medicare, Medi-Cal, Managed Care, Commercial insurance, and Tribal FQHC billing. Must have experience with medical terminology, ICD-10-CM, CPT, HCPCS codes, cash/receipt procedures, and interpreting EOBs and ERAs. Candidate must have strong problem-solving, organizational, communication, and computer skills. Experience with practice management software and NextGen EHR is preferred. The Insurance Billing Clerk is responsible for accurately and promptly submitting claims to Medicare, Medi-Cal, commercial insurers, managed care, and other third-party payers. This position ensures claims are submitted correctly, monitors claim status, resolves billing issues, follows up on unpaid claims, and supports revenue cycle performance while maintaining compliance with payer, federal, state, and organizational requirements. The position works closely with providers, coding staff, patient registration, payment posting, denials/appeals management, collections, insurance credentialing, and insurance companies to ensure optimal reimbursement and compliance with all applicable requirements. Must be able to work with the Indian Community, and be sensitive to the Indian culture and its needs.
Major Duties and Responsibilities:
- Utilize the Practice Management (PM) system to review, edit, and submit claims accurately and in a timely manner through Waystar or the designated clearinghouse.
- Monitor claim edits, rejections, and clearinghouse reports. Promptly correct and resubmit rejected claims, and follow up on unpaid, denied, or underpaid claims.
- Correct demographic, coding, insurance, and billing errors identified in Waystar edits.
- Reconcile claims transmitted through the clearing house with claims accepted by payers.
- Review electronic remittance advice (ERA) and claim status reports.
- Utilize Waystar claim status and eligibility tools to research claim issues.
- Escalate recurring clearinghouse or payer issues to revenue cycle leadership.
- Assist with implementation of payer-specific billing requirements and clearinghouse updates.
- Monitor timely filing deadlines and resubmit corrected claims as necessary.
- Contact insurance companies regarding claim status and reimbursement issues, and document all account activities in the billing system.
- Analyze denials to identify root causes, submit corrected claims and appeals with supporting documentation, maintain denial-tracking logs, and assist with denial reduction efforts.
- Work assigned aging reports, monitor timely filing deadlines, assist with collections and account resolution, and escalate complex reimbursement issues as needed.
- Maintain productivity and quality standards established by the Revenue Cycle Department.
- Support process improvement initiatives to reduce denials and increase cash collections.
- Maintain compliance with HIPAA and patient confidentiality requirements.
- Follow Medicare, Medi-Cal, managed care, and commercial payer billing regulations.
- Report billing errors, compliance concerns, or potential overpayments, and maintain accurate records of billing activities.
- Respond professionally to patient and payer inquiries, and assist patients with billing and insurance questions.
- Communicate effectively with internal departments regarding claims issues.
- Review the diagnosis and the procedures. Ensure that claims have appropriate provider, provider number, billing address and coding to match FQHC Guidelines for Medicare and Medi-Cal claims processing.
- Submit all secondary insurance (i.e., Medi-Cal and group insurance) on medical claims with remittance advice attached.
- Adjust accounts as needed in system (i.e. no insurance coverage, services not covered) under the guidance of the revenue cycle lead.
- Responsible for maintaining a consistent attendance record and free of tardiness. Quantity and quality expectations of work based on full time equivalent.
- Self-development – Attend any insurance seminars or staff meetings as needed.
- This position requires working weekends and evenings, if needed.
- Other duties as assigned relevant to the position, with relevant training and competency assessment documented
- Prepare, review, and submit paper claims to insurance carriers, ensuring accuracy, completeness, and compliance with payer requirements.
Qualifications
Education:
High school graduate or equivalent. Diploma in Medical Coding and Billing is preferred.
Certification as a Certified Professional Biller (CPB) is required
Experience:
- Minimum of two years of experience billing Medicare, Medi-Cal, and Managed Care Plans (IEHP, Molina, Blue Shield, and Kaiser), as well as FQHC encounter billing, is required.
- Minimum two years of experience with medical terminology, ICD-10-CM diagnosis, CPT procedures, and HCPCS codes is required.
- Experience with Tribal FQHCs or Community Health Centers is preferred but not required.
- Minimum two years of experience using NextGen Practice Management, Waystar Clearinghouse, and electronic remittance systems is preferred.
- Minimum two years of experience in customer service and medical billing is preferred.
Certification:
CPR (BLS Provider) certification through the American Heart Association (AHA) or the American Red Cross. Certification may be obtained prior to orientation. Certification may obtained within 90 days of employment.
Knowledge of:
Knowledge of Insurance companies requirements. The incumbent must also be knowledgeable about the unique differences between rural and primary billing as it relates to Medi-Cal billing. Must also be familiar with Cash Flow concepts and cash/receipt procedures. Proficient in medical terminology, basic ICD-10-CM diagnosis, CPT procedures, and HCPCS Codes. Experienced with Medicare, Medi-Cal, Managed Care, and Commercial insurance, and Tribal FQHC billing requirements. Skill in interpreting explanation of benefits (EOBs) and Electronic Remittance Advice (ERAs).
Skill:
Demonstrates excellent problem-solving, strong attention to detail, and effective organizational skills. Communicates effectively both verbally and in writing to convey and receive information. Experience with practice management software/NextGen EHR preferred. Must demonstrate ability to organize work in a logical manner. Proficient in the use of computers and software, including but not limited to practice management software, word processing, and spreadsheet applications. Must understand or be willing to receive Native American cultural competency training and employ cultural awareness with our Native American community.
Ability to:
Maintain strict confidentiality procedures. Can consistently meet productivity and accuracy goals. Ability to multi-task and meet tight deadlines. Works well with others, supports coworkers, shares knowledge, and helps achieve team and company goals by collaborating with both internal and external partners. Maintains professional relationships, helps create a positive and respectful workplace, and delivers excellent customer service and strong results.
Must be able to work with the Indian Community, and be sensitive to the Indian culture and its needs.
Physical Demands:The work is mostly sedentary. However, the employee must be able to carry items weighing up to 25 pounds. The work is normally performed in an office setting. Dexterity of hands with coordination of eye and hand movement.
Schedule:
Monday-Thursday 7:00am-4:00pm, Friday 7:00am-1:00pm
This position is eligible for hybrid telework upon successful completion of 90-day introductory period, Eligibility is subject to supervisor approval, position requirements, and organizational needs.
Appointment Type:
Full-Time, Non-Exempt
Compensation:
$22.00–$23.00 per hour ($45,760–$47,840 annually, depending on experience and internal equity)
Clinic Location:
San Manuel Indian Health Clinic (11980 Mt. Vernon Ave. Grand Terrance Ca, 92313)
Pay: $22.00 - $23.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
