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Medical Biller

Job Location: APHCV-Administrative Office
Position: Full Time

DUTIES AND RESPONSIBILITIES:

  1. Review and process the submitted CPT and ICD codes by running the Pending EHR Manual Charge Processing Report from NextGen EPM on a daily basis.
  2. Consult with providers if the submitted charge is incomplete or insufficient for billing.
  3. Consult with the appropriate staff, i.e. Front Office Staff, Clinic Coordinator, Clinic Manager, NextGen Application Support Staff, or Medical Assistant if the information for claim completion is incomplete.
  4. Accurately process all charges in NextGen EPM to include office visit, procedure, immunization, medicine, lab, radiology, and others.
  5. Process paper claim billing for CHDP using PM160 and Managed Care LA Care using CMS1500 on a daily basis and mail out every two weeks.
  6. Apply patient’s payment posted by Front Office Staff as an encounter credit to the patient’s encounter on a daily basis. Consult with the appropriate Clinic Support Staff or Floor Coordinator if there is a payment discrepancy.
  7. Process adjustment on any difference between billings and payments.
  8. Post payments from the assigned third party payors in NextGen EPM within the next day of receipt.
  9. Prepare and send patient statements of account to Sliding Fee Discount Program/Self-Pay patients and patients with copayment/coinsurance with the minimum balance of $5.00 on a monthly basis.
  10. Review the assigned denials, investigate, make a correction, and re-bill accordingly within 2-3 days of receipt of Explanation of Benefit or Remittance Advice.
  11. Assist patients and other staff with billing and insurance coverage questions and complaints.
  12. Maintain up-to-date billing activities.
  13. Perform other duties that may be assigned from time to time.

QUALIFICATIONS:

  • Associate degree in billing or 1year minimum experience as a biller in a non-profit health care organization
  • Proficiency in Microsoft Office Applications
  • Experience in NextGen preferred

HR PROCEDURAL REQUIREMENTS:

  • Legal authorization to work in the United States
  • A valid California Driver’s license with clean records and access to insured automobile
  • Completion of APHCV Health Assessment Form
  • Completion of DOJ background check

PHYSICAL REQUIREMENTS:

Must be able to materially perform the task normally associated with the position including but not limited to: ability to lift 25 to 30 lbs.