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Claims Follow up Specialist

Roots Community Health Center

Claims Follow up Specialist

Oakland, CA
Full Time
Paid
  • Responsibilities

    Job Description

     

    POSITION SUMMARY: The CLAIMS FOLLOW UP SPECIALIST represents Roots Community Health Center, working as part of a team in a highly visible setting. This position provides support to the Direct of Billing, insurance carriers, with team members/clinic personnel, employees of other departments, payers and insurance plans.

    ESSENTIAL FUNCTIONS: 

    ●        Review paper and electronic denials (EOB’s)

    ●        Conduct insurance follow-up on all final billed claims

    ●        Conduct research on denied claims and take steps toward resolution

    ●        Correct errors and resubmit claims  to payers (AMD)

    ●        Conducts account follow up including the investigation of payment delays resulting from pending claims with the objective of                            appropriately maximizing reimbursement based upon services delivered and ensuring claims are paid and settled in the most timely                manner

    ●        Review patient demographics and scanned documents for accuracy

    ●        Update insurance plans and carrier information

    ●        Verify insurance information/PCP assignment

    ●        Ensure/verify the accuracy of patient demographics and insurance information in Electronic Health Record

    ●        Report tends and denial patterns to the Director of Billing

    ●        Other duties as assigned

    SECONDARY FUNCTIONS:

    ●        Participate in internal chart audits, billing audits, and other compliance programs

    ●        Implement policies and procedures relating to payer billing guidelines

    ●        Implement new processes, projects, etc. as needed

    EDUCATION REQUIREMENTS:

    High School Diploma or GED

    WORKED EXPERIENCE REQUIREMENTS: 

    ●        Must have experience working in non-profit organization or a community clinic preferred, but not required.

    ●        Minimum 1 years’ experience performing medical billing, claims review

    ●        Minimum 1 years’ experience with claims follow-up from physician office, third-party setting

    ●        Familiarity with medical terminology and the medical record coding process

    ●        In-depth knowledge/ awareness of all areas related to Payer-specific (Medicare MediCal Medicaid and/or Private) Claims and how                  they interrelate

    ●        Knowledge of principles methods and techniques related to compliant healthcare billing/collections - Familiarity with Payer-specific                 (Medicare MediCal Medicaid Private) Claims management functions in acute and non-acute settings

    ●        Previous experience with either Electronic Health Record

    ●        Full understanding of insurance denials/appeals process

    ●        Previous experience with HCFA 1500 claim forms and electronic billing.

    ●        Interest/experience working with low-income communities of color

    ●        Excellent written and verbal communication skills

    ●        Solid organizational skills including attention to detail and multi-tasking skills.

    ●        Demonstrates ability to manage time efficiently and multi-task effectively.

    ●        Clear and effective external and internal, verbal and written, communication skills.

    ●        Strong critical thinker and problem solver

    ●        Excellent team-player

    ●        Ability to work with patients from different backgrounds

    ●        Ability to communicate clearly and respectfully with co-workers and clients

    ●        Strong working knowledge of Microsoft Office

    ●        Ability/willingness to learn Electronic Health Records            

    QUALIFICATIONS AND DESIRED CHARACTERISTICS:

    ●        Solid organizational skills including attention to detail and multi-tasking skills

    ●        Demonstrates ability to manage time efficiently and multi-task effectively

    ●        Clear and effective external and internal, verbal and written, communication skills.

    ●        Strong critical thinker and problem solver who can successfully build and lead an execution strategy from a long-term vision

    ●        Excellence in organizational management with the ability to develop high-performing multi- disciplinary teams across an organization;              experienced working in a multi-site environment.

    ●        Experienced strategist, innovator, and executor who will contribute in the leadership, management, and growth of the organization;                  adept at synthesizing information, building stakeholder trust and making sound decisions

    ●        Passion and knowledge of skill-based workforce development programming and social enterprise

    ●        Strong working knowledge of Microsoft Office

    ●        Ability to work with people from diverse backgrounds; strong interpersonal communication skills;

    ●        Ability to work under pressure; good sense of humor; flexible and participant;

    ●        Ability to work independently as well as in a team setting;

    ●        Detail-oriented with good organizational skills;

    ●        Good computer skills;

    ●        Willingness to work a flexible schedule;

    ●        Valid California Driver License with safe driving record.

    PHYSICAL CONDITIONS:

    ●        Frequent walking, standing, stair climbing, bending, stooping, lifting (25 lbs. max)

    ●        Gross and fine manual dexterity;

    ●        Must be able to visually observe staff to understand and interpret non-verbal behavior;

    ●        Able to operate standard office machines and equipment including keyboards.

    ●        Able to operate standard office machines and equipment including keyboards.

    Company Description

    The mission of Roots Community Health Center is to uplift those impacted by systematic inequities and poverty by providing culturally competent, comprehensive healthcare, mental health, and wraparound services, and by emphasizing self-sufficiency and community empowerment. Roots Community Health Center accomplishes its mission by providing top-quality healthcare, conducting community-based participatory research, and offering opportunities for rehabilitation, education, training, and employment to reduce poverty and dependency in our community. Roots implements its programs and services while honoring the “roots” of culture, heritage, and tradition; by providing unprecedented access to services; by remaining community-aware and community-responsive; and by establishing partnerships to ensure a more efficient continuum of care in Oakland. Do you care deeply about making a difference in our community? Roots is a great place to call home! We are a young, growing organization with a very strong, experienced and dedicated team. We believe in continuous learning and training for our staff and provide a supportive environment in which to grow. Please submit a cover letter specific to the position posted and a current CV/Resume to careers@rootsclinic.org.