Medical Biller/Collector - OSNC

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Overview

Tri-City Healthcare District has been serving the North County region for almost 60 years and remains committed to providing high quality healthcare and community services for every individual we encounter regardless of race, color, ethnicity, gender, sexual orientation, disability or socioeconomic status.

Our mission is to advance the health and wellness of the community we serve. In order to achieve our mission, we see, hear and listen to our front line healthcare workers, employees, medical staff and all community stakeholders in order to understand and meet our community’s needs.

Position Summary:

The medical biller/collector is responsible for timely submission of claims to insurance companies from a wide variety of medical providers and facilities, as well as monitoring and ensuring payments for medical services are received in a timely manner.  The person in this position may also function as an intermediary between health care providers, clients, patients and health insurance companies.

Major Position Responsibilities:

The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization.

• Maintains a safe, clean working environment, including unit based safety and infection control requirements.
• Reviews patient bills for accuracy and completeness; obtains missing information
• Knowledge of insurance company or proper party (patient) to be billed; identify and bill secondary or tertiary insurances
• Utilize a combination of electronic health record (EHR)  to perform billing duties; maintain an accurate, legally compliant medical record
• Process claims as they are paid and credit accounts accordingly
• Review insurance payments for accuracy and compliance with contract discounts
• Review denials or partially paid claims and work with the involved parties to resolve the discrepancy
• Manage assigned accounts, ensuring outstanding/pending claims are paid in a timely manner and contact appropriate parties to collect payment
• Communicate with health care providers, patients, insurance claim representatives and other parties to clarify billing issues and facilitate timely payment
• Consult supervisor, team members and appropriate resources to solve billing and collection questions and issues
• Maintain work operations and quality by following standards, policies and procedures; escalate compliance issues to Business Office Manager.
• Prepare reports and forms as directed and in accordance with established policies
• Perform a variety of administrative duties including, but not limited to: answering phones, faxing and filing of confidential documents; and basic Internet and email utilization
• Provide excellent and professional customer service to internal and external customers
• Function as a contributing team member while meeting deadlines and productivity standards

Qualifications:

• Minimum of 1 year of experience posting in a health care setting.
• Strong background in customer service.
• Competencies in the areas of leadership, teamwork and cooperation.
• Strong ethics and a high level of personal and professional integrity.
• Ability to understand medical/surgical terminology.
• Educated on and compliant with HIPAA regulations; maintains strict confidentiality of patient and client information.
• Extensive knowledge on use of email, search engine, Internet; ability to effectively use payer websites
• Preferred experience with billing systems such as GE Centricity & SRS Caretracker
• Strong written, oral and interpersonal communication skills; Ability to present ideas in a business-friendly and user-friendly language; Highly self-motivated, self-directed and attentive to detail; team-oriented, collaborative; ability to effectively prioritize and execute tasks in a high pressure environment
• Ability to read, analyze and interpret complex documents. Ability to respond effectively to sensitive inquiries or complaints from employees and clients. Ability to speak clearly and to make effective and persuasive arguments and presentations

Education: 

• High school diploma or equivalent, required.
• Associate’s Degree in Business Administration, preferred.

Certifications:

• Certified Medical Reimbursement Specialist (CMRS) certification, preferred.

Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.

*Salary/Hourly Wage range based on experience.

To protect the health of patients and staff, and to comply with the new State of California mandates, all job offers are contingent on the successful engagement in the TCMC COVID-19 vaccination program (fully vaccinated with documented proof or approved exception/deferral.)

TCHD is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with a disability.