Billing Specialist

Description

Wellness Equity Alliance (WEA) is a novel national public health organization comprised of a multidisciplinary team of population and public health experts with backgrounds in infectious disease, public health, emergency medicine, primary care, cardiology, pediatrics, psychiatry, community health work (CHW), nursing and advanced practice pharmacy. We work nearly exclusively with underrepresented communities, fundamentally addressing health-care disparities and the social determinants of health (SDoH) that have been amplified during the COVID-19 pandemic, prioritizing the following:

• People experiencing homelessness
• Indigenous communities
• Immigrant communities
• Rural communities
• BIPoC communities
• LGBTQIA+ communities
• Justice-impacted communities
  
  

The WEA team is diverse, inclusive, and nimble enough to assemble teams of healthcare professionals within days using our proven local staff recruitment models to address population health crises and communicable disease outbreaks. The WEA team’s partnership model is collaborative and allows hospitals, health jurisdictions, state/local government agencies to provide timely care using equity-based strategies for individuals and marginalized communities.

Elevate your career to new heights with an opportunity that transcends traditional healthcare boundaries!

Wellness Equity Alliance is actively seeking a compassionate and driven individual for a billing specialist position to join our medical facility’s administrative team to process patient billing information. Working for WEA is more than a job; it's a calling to serve those who are most in need, directly in their environment.

Purpose of the position The Billing Specialist is responsible for managing the financial aspects of patient care, ensuring that medical services are accurately coded and billed to insurance companies and patients. This role is crucial in maintaining the financial health of the organization by efficiently processing claims, managing accounts receivable, and resolving billing discrepancies. The Billing Specialist serves as a key liaison between the healthcare provider, patients, and insurance companies, ensuring compliance with all regulatory requirements and maintaining the confidentiality of patient information. Through meticulous attention to detail and strong communication skills, the Billing Specialist helps facilitate timely reimbursements and provides essential support to the overall revenue cycle management process.

Key Responsibilities

• Claims processing:
• Submit insurance claims electronically or through hard copy to insurance companies
• Follow up on unpaid or incorrectly processed claims
• Resolve billing discrepancies and calin rejections
• Verify patient information and update insurance details
• MediCal coding:
• Assign accurate codes using ICD-10, CPT, and HCPCS coding systems.
• review medical records to ensure proper coding and documentation
• Compile billable codes for Enhanced Care Management, CalAIM Initiative
• Reconcile with internal team to help assist with accurate ECM reporting
• Patient Communication:
• Communicate with patients to obtain insurance information and verify eligibility
• Advise patients of co-pays, balances due, and payment arrangements
• Assist patients in enrolling in various insurance programs like Medi-Cal, Madgellan.
• Compliance and Documentation:
• Ensure adherence to HIPAA regulations and maintain confidentiality of patient information
• Stay updated on billing and reimbursement regulations, including Medicare, Medi-Cal, and third-party insurance requirements
• Participate in regular audits and reviews to ensure compliance.
• Payment Processing
• Apply payments received from patients and insurance companies to appropriate accounts.
• Reconcile accounts receivable balances and ensure accuracy.
• Denial Management:
• Identify and resolve claim denials by insurance companies, including researching reasons for denial and resubmitting claims.
• Prepare and submit appeals for denied claims as necessary
• Reporting
• Prepare and submit regular financial reports, including accounts receivable aging reports and revenue cycle analysis.
• Analyze billing data to identify trends and areas for improvement in the billing process.
  

Requirements

Qualifications and Education Requirements

• High school diploma or equivalent;
• Certification in medical billing and coding preferred.
• 2 or more years of experience in medical billing or insurance claims processing roles preferred.
• Familiarity in the 340B program is a plus.
• Proficiency in Spanish is a plus
  
  

Preferred Skills

• Proficient in medical coding using ICD-10, CPT, and HCPCS systems.
• Knowledgeable in processing insurance claims and handling claim denials.
• Familiarity with reimbursement methodologies and insurance policies.
• Proficient in medical billing software
• Solid understanding of medical terminology and anatomy.
• Effective verbal and written communication skills.
• Strong attention to detail and accuracy in documentation.
• Ability to handle multiple phone lines and manage inquiries from patients and insurance companies.
• Problem-solving skills to address billing discrepancies and issues.
• Strong organizational abilities to manage multiple tasks and meet deadlines.
• In-depth knowledge of HIPAA compliance and patient privacy regulations.
• Understanding of billing and reimbursement regulations, including Medicare, Medicaid, and third-party insurance requirements.
• Ability to maintain a professional demeanor at all times, take initiative and be flexible and cooperative.
• Self-motivated and independently productive.
• Ability to work effectively with both employees and managers.