Medical Policy Specialist jobs in Fresno, CA

Position: Medical Billing Specialist

Primary Duties:

With precision and accuracy, prepare and submit each claim. Ensuring each goes out clean, with up-to-date medical information and billing codes, to guarantee accurate payment at first submission. As necessary, perform any follow up tasks required in pursuit of proper payment.

• Meet daily, monthly and quarterly collection goals set by billing supervisor.
• Process number of accounts per day as assigned.
• Analyze EOBs and construct response to insurance carriers based on claim adjudication.
• Manage AR of assigned accounts including processing insurance denials and or appeals, which may include phone contact with insurance companies.
• Follow up with payers and other appropriate parties to collect open balances in a timely manner, ensuring compliance with payer guidelines.
• Initiate refund requests for supervisor’s approval.
• Identify and report payer issues with regard to rejection trends, denial trends, or change in payments. Communicate specific payer information to appropriate parties and or departments.
• Identify and address denial and or zero payments and correct billing submissions.
• Follow up and complete tasks on pending accounts in a timely manner and until account is settled.
• Other job duties as assigned.

Other Job Criteria:

• Exhibit high levels of customer service and communication skill, verbal and writing, in all interactions both internally and with outside companies.
• Ability to proficiently utilize all company technology to perform job duties (e.g., answer phones, send emails, and updating patient accounts as needed).
• Blend education, skills and experience on an ongoing basis.
• Ability to work in a team setting and independently with minimal supervision, alternating between each as circumstances require.
• Advanced time management skills, efficiently complete job duties with extreme accuracy.
• Advanced organization skills, using professional judgment to prioritize high volume workload.
• Maintain patient and job confidentiality, ensuring compliance with HIPAA standards.
• Appearance and habits do come to work with presentable personal hygiene and attire.
• Reliable, dependable, and able to maintain job attendance with minimal absence.
• Perform job duties in spite of unforeseen obstacles, with versatility and positive personal temperament under stress and or pressure.
• Sitting and for long periods of time.

Education/Experience:

• High School Diploma or GED
• Two or more years of experience in medical accounts receivable (AR), claims billing, appeals, processing denials, and submitting electronic data interchange (EDI) claims.
• Extensive experience and proficiency in date entry.
• Proficiency in explanation of benefits (EOB) analysis, payment adjustments, and medical terminology.
• Proficiency in understanding of CPT and HCPCS codes, AR follow-up, and payment reconciliation, and all revenue cycle functions and interrelationships.

Job Type: Full-time

Pay: $39,520.00 - $52,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off

Schedule:

• Monday to Friday

Work setting:

• Medical office
• Office

Experience:

• Medical coding: 1 year (Preferred)
• Medical Payment Posting: 1 year (Preferred)
• EHR systems: 1 year (Preferred)
• Medical billing: 1 year (Preferred)

Work Location: In person