OHS Medical Biller (Administrative)

Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for a OHS Medical Biller in City, CA.

Assures timely eligibility for appointments, working with OHS dashboard, billing and reimbursement of clean claims, corrects denied claims, appeals denied or delayed claims for OHS payers in order to receive reimbursement for healthcare claims. Responsible for verifying eligibility for online health appointments, working directly with OHS dashboard, creating patient accounts with patient demographics in EHR system, creating claims and billing to OHS payers with claims follow up.

 

At PPOSBC, we understand the importance of a well-rounded benefits program and are dedicated to providing you with unique benefits that meet the needs of you and your family. We are proud to offer a range of plans that help protect you in the case of illness or injury including:

• A competitive benefits package including medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability. 
• Benefits coverage starts after one full month of employment!
• Generous vacation, sick, and holiday benefits!
• Generous 401(k) matching contributions and more!
• To view our detailed benefits guide, please visit our career site at www.pposbccareers.org

Responsibilities

Essential Functions: Essential functions encompass the required tasks, duties and responsibilities performed as part of the job and the reason the job exists.

• Knowledge of payer guidelines.
• Knowledge of industry standard and Medi-Cal denials reasons/codes.
• Knowledge of several different coding systems, including Level 1 HCPCS and Level 2 HCPCS.
• Understand and verify eligibility.
• Setup patient accounts in practice management system.
• Submit claims daily to insurances.
• Ensure all Online Health Services appointments are billed.
• Follow up on claim submissions to determine batch acceptance, rejection, or denial.
• Communicates with RCM leadership about payer updates, changes, and requirements.
• Investigates insurance fraud and reports if found.
• Maintains strict confidentiality.
• Other duties as assigned by Manager of Revenue Cycle Management. 

Non-Essential Functions:

• Other duties as assigned. 

PHYSICAL REQUIREMENTS:

The physical requirements of this position are identified below. Reasonable accommodations may be made for individuals with disabilities to perform the essential functions of this position.

CORE COMPETENCIES – WE CARE:

• Welcoming: Anticipates customer requirements and gives high priority to customer satisfaction and service.  Handles problems quickly and efficiently.  Maintains a pleasant, positive and professional approach. Embraces opportunities to help team members, stakeholders, and other departments.
• Equitable: Creating equitable access and opportunity for all through education, practicing inclusive behavior, elevating others' voices, creating spaces for honest conversation, and listening without judgment.  Values and uplifts our collective diversity within in our agency.
• Confidential: Respects the information shared by our patients, employees, and vendors and maintains appropriate confidentiality.  Follows all policies and laws that protect private & privileged information.
• Accessible: Is available and approachable to others, open-minded, fair and non-defensive.  Appreciates constructive feedback and is a team player.  Demonstrates good listening skills.
• Respectful:  Values diversity and treats everyone with dignity and courtesy.  Dependable and courteous of other people's time and commitments.
• Empathetic: Demonstrates interest and understanding in other people's feelings, attitudes and reasoning.  Maintains an open and non-judgmental demeanor that is patient, flexible, and understanding.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Licensure and/or Certification Requirements:

• Billing certificate preferred. 

Minimum Education:

• Associates or Bachelor's Degree preferred or equivalent experience in related field.

 

Minimum Work Experience:

• 2 years of experience as a medical biller/claims follow-up specialist or collections specialist in an outpatient medical setting (non-hospital) in primary care, family planning and telehealth.
• Medical terminology.
• Computer database management (electronic practice management system). EClinicalWorks/NextGen experience preferred.
• A minimum of 2 years of experience in Billing and coding procedures.
• A minimum of 2 years of experience with insurance billing and reimbursement procedures.
• A minimum of 2 years of experience with HIPAA 5010 transaction standards.
• A minimum of 2 years of experience claims follow-up/appeals and health plan Accounts Receivable management for specific payers. 

Other Requirements:

• Strong verbal and written communication skills are essential.
• Ability to demonstrate mature judgment, initiative and critical thinking.
• Strong follow-up skills and time management with internal and customer stakeholders.
• Ability to maintain confidentiality.
• Accuracy and attention to detail is essential.
• Professional demeanor at all times.

 

Agency Standard Requirements:

• Strong commitment to quality healthcare and excellent customer service is required.
• Must thrive in a fast paced, rigorous environment with changing priorities.
• Ability to meet deadlines and work under pressure.
• Must demonstrate high level computer skills including; Microsoft Word, Excel and Outlook. Electronic medical records experience may also be required.
• Abortion patients are cared for at each of our health centers and in part through the administrative, support, and other non-clinical services provided at all PPOSBC locations and by all PPOSBC employees, and supporting these critical services is an essential job duty and fundamental responsibility of all employees.