One Community Health
  • 09-May-2018 to 08-Jul-2018 (PST)
  • Sacramento, CA, USA
  • Full Time

Health Center Billing Specialist


The Health Center Billing Specialist will be responsible for all aspects of the Revenue Cycle, including but not limited to: insurance verifications, billing, insurance and patient collections, cash payment posting, and patient services. To bill and adjust claims, follow-up on unpaid claims, process adjustments, collect on accounts, process a variety of documents, perform a variety of miscellaneous tasks as requested and/or perform customer service duties to ensure that monies due OCH are secured and paid in a timely manner and the AR outstanding days of revenue are kept to a minimum.


Essential Functions


  • Posting of Payments and Adjustments

Posts patient payments and electronic insurance remittances to the appropriate invoice with accuracy and timeliness; Completes appropriate batch summary sheets and balances all receipts to deposits. Posts insurance explanations of benefits, including zero payments, taking the appropriate contractual adjustments reflective of OCH managed care contracts in force at the time of service.


  • Billing

Employ effective and efficient billing techniques, and self-directed initiative, to resolve all types of billing edits.  Validate claims and make necessary corrections to send out clean claims to the payers electronically and/or via paper. Compile and submit claims to insurance companies based on data provided by the medical coders. Review first initial claim scrub and billing to the clearinghouse utilizing billing and practice management software.


  • The Aging Report, Denial Management, and Follow-up

Follow up on all open encounters that are Medicare, Medi-Cal, and commercial payers.

Conduct insurance verification and validation as needed to ensure eligibility and benefits are in order for accurate claim submission and paymentResearch and resolve patient issues, respond to inquiries by center staff regarding patient account issues, and assist with patient statements. Work with management in identifying, researching, and resolving issues which may lead to inaccurate or untimely filing of claims, claim rejections, and/or other billing and collections issues which may ariseAssist management team in providing training, assistance, and/or guidance to other staff members in issues of accounts resolution through billing, collections, and/or denial processing techniques.


Education & Experience Required:

  • High School Diploma, GED or equivalent
  • Billing and Coding Certificate preferred or experience of 2 to 5 years, in a medical office or healthcare business office.
  • FQHC, RHC or HIS experience preferred.



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