Job Title: Medical Billing Specialist
Location: Livermore, CA – Onsite – Local candidates only
Period: 12 /09/2024 to 12/09/2025 - possibility of extension
Hours/Week: 40 hours
Rate: $23/hour (Hours over 40 will be paid at Time and a Half)
Contract Type: W-2

Scope of Services:

The Medical Billing Specialist assures that all phases of processing client information are in compliance with HIPAA, PHI regulatory and related policies and practices; reports any Compliance issues to the Director of Operations. Coordinates the insurance verification process and makes sure that the client understands their co-pay responsibility. Responsible to follow-up as necessary to facilitate the collection of co-pays. When applicable may gather credit card or other payment processing information from client and enters into system to process payment for account. Manages the entry of client information into computer system in a timely manner and contact of referral source, customer and/or client to obtain missing information needed to set up client for service. Confirms all sales orders in the system and ensures that all required information (e.g. proof of delivery, signed prescription, signed acknowledgement form, etc.) is on file before submitting claim for payment. Follows up on all missing sales orders and reconciles billing questions on a regular basis until payment status is complete.

Role, Responsibilities, and Deliverables:

• Compliance and Regulatory Adherence:
  • Ensure compliance with HIPAA and PHI regulatory policies throughout all phases of client information processing.
  • Stay updated on current regulatory guidelines and reimbursement information to ensure accurate billing and reimbursement.
  • Report any compliance issues to the Director of Operations promptly.
• Claims and Payment Processing:
  • Submit electronic and paper claims to payers in a timely manner.
  • Correct and resubmit front-end and back-end rejected claims.
  • Ensure all cash is posted to the correct account promptly.
  • Facilitate the collection of co-pays through timely follow-up.
  • Gather and enter credit card or other payment processing information from clients into the system for payment processing.
• Accounts Receivable Management:
  • Follow up and collect payments due to the organization by generating invoices and following up with clients and/or payers.
  • Prioritize and manage accounts to resolve high priority-high dollar accounts and aging.
  • Complete AR adjustments where appropriate.
  • Accurately document accounts collection notes.
  • Follow work list prioritization of accounts as established by department policies and procedures.
  • Demonstrate knowledge of government payers' guidelines (Medicare/Medicaid).
• Insurance and Billing Coordination:
  • Coordinate the insurance verification process, ensuring clients understand their co-pay responsibilities.
  • Manage the timely entry of client information into the computer system, ensuring accuracy and completeness.
  • Confirm all sales orders in the system and ensure that all required documentation (e.g., proof of delivery, signed prescriptions, signed acknowledgment forms) is on file before submitting claims for payment.
  • Follow up on missing sales orders and reconcile billing questions regularly until payment status is complete.
• Customer Service and Support:
  • Perform other duties/projects as assigned by management, including processing, resolving, and logging customer inquiries.
  • Provide customer service support as needed, ensuring effective and prompt resolution of customer issues.
• Appeals and Claim Research:
  • Process appeals and research claims, following specific payer guidelines for appeals submission.

Experience:

• Backend experience working with appeals AR follow-up experience.
• Minimum of 2 years of experience in medical billing or related field.
• Proficiency in medical billing software systems such as [insert specific software names].
• Demonstrated understanding of HIPAA and PHI regulatory requirements.
• Experience in coordinating insurance verification processes and managing co-pay collections.
• Proven track record of accurately entering and managing client information in computer systems.
• Familiarity with claim submission processes and experience in correcting and resubmitting rejected claims.
• Strong communication skills with the ability to effectively interact with clients, payers, and internal teams.
• Prior experience in handling customer inquiries and providing excellent customer service.
• Ability to work independently and as part of a team in a fast-paced environment.
• Previous training or certification in medical billing or related field is a plus.