Medical Claims Review Manager jobs in Modesto, CA

JOB TITLE: MEDICAL CLAIMS BILLER

REPORTS TO: BILLING OFFICE LEAD/BILLING OFFICE DIRECTOR

Rate of pay/Salary : 33,280.00 annual salary/ DOE

BASIC FUNCTION: Performs a variety of functions within the billing process that includes statements, correspondence, refunds, denials, rebills, collections & customer service. Prepares medical claims for electronic & paper submission to patients, insurance companies, Medicare, Medi-Cal and other financially responsible payors. Facilitates a fluid process of billing claims in a timely & successful manner.

RESPONSIBILITIES:

• Review & ensure that the charts & claims are in compliance with federal, state, legal & insurance guidelines, requesting addendums as needed
• Analyze & code EMS procedures & diagnosis using ICD-10 & HCPC codes
• Verify patient payor sources for services & maintain payor information in the billing software
• Enter all ticket information into billing system in an accurate & timely manner
• Prepare & submit electronic & paper claims within established cycle & month-end deadlines
• Use work flows regularly to insure all pending/denied/underpaid claims are processed within designated time frames
• Process denials/underpayments/overpayments & search for supporting documentation to support claim appeals and follow up as directed.
• Respond to patient/payor inquiries regarding claims
• Attend training seminars & conferences as requested
• Cross train/assist in other billing specialty areas as required by management
• Establish a good rapport and professional working relationship with all departments & readily assist coworkers
• Follow all company policies & procedures related to HIPAA regulations, patient privacy & protected health information

QUALIFICATIONS:

• Knowledge of commonly used concepts, practices & procedures of the medical billing industry
• Proficient in typing, word processing, Microsoft Outlook & billing software
• Ability to work independently, follow directions, set priorities, meet deadlines & adapt to change
• Good organization/communication/customer service skills
• Must be able to read, write and understand the English language.

PHYSICAL REQUIREMENTS:

Requires routine walking, standing, bending, reaching, squatting, lifting and carrying items weighing less than 40 pounds. Requires working at computer workstation for extended periods.

JOB RESPONSIBILITIES RELATED TO PATIENT PRIVACY

PROTECTED HEALTH INFORAMTION ROLE BASED ACCESS

Access to PHI will be limited to those who need access to PHI to carry out their duties. The following describes the specific categories or types of PHI specific to this job description: