Billing Specialist II

Here at SNAHC, you are joining a team and company at a time of growth and transformation. You will love being surrounded by people who are as passionate as you are about healthcare and giving back to the community. Please note that individual total compensation for this position will be determined at the Company's sole discretion and the wage range for this role considers a wide range of factors including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. At SNAHC, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $41,399.19-$56,010.67

Position Summary:

The Billing Specialist II is responsible for the quality assessment of coding assignments. The Billing Specialist II is responsible for assisting in the processing of all types of payments, claims, denials, refunds, and unapplied payments ensuring that all necessary data is adjudicated in a timely manner. This role is a part of provider support team, providing documentation guidelines and updates periodically.

Essential Functions:

• Coordinate the collection of data from point of origin; participate in the pre-processing of patient data to locate missing information and to make corrections as necessary.
• Submit claims on a daily basis.
• Ensure that payments received are correctly posted in the account receivables.
• Share patient payment information on a daily basis.
• Review Sphere 2 provider training documentation.
• Point of contact for state programs including, but not limited to CHDP, Family Pact, Every Women Counts, etc.
• Process daily pending charges.
• Balance batch ledgers when necessary.
• Run and correct any claim edits.
• Run report to check for missing charges from providers.
• Serve as support and provide training for providers when needed.
• Work daily tasks from E.P.M. And E.H.R work logs.
• Stay current and update RCM with any payer specific or FQHC facility information changes.
• Reviews provider coding for accuracy in outpatient medical, dental, and behavioral health records.
• Respond to all levels of coding, billing escalated questions related to account balances in Dental, Medical, and Behavior Health location.
• Analyze and resolve Revenue Cycle problems effectively by utilizing weekly aging reports to ensure all claims are adjudicated in a timely manner.
• Update patient records when necessary.
• Files and maintains transmittals for billing and auditing processes including refunds and overpayments.
• Research problem claims, and adjust errors discovered therein.
• Review billing database for trends in claims rejections and resolve these as they occur.
• Review and resolve claim denials.
• Maintain high degree of confidentiality and respect in handling all clinic and client medical information.
• Purging charts that have aged out.
• Compliance with all state and federal laws and regulations, as they pertain to position including; HIPAA, sexual harassment, scope of practice, OSHA, etc.
• Other duties as assigned.

Minimum Qualifications:

• AA degree or equivalent experience in insurance, eligibility and/or billing.
• 3 years or more recent Medi-Cal, Medicare, and outpatient coding experience or equivalent combination of education.
• Familiarity with computerized Billing systems used for third Party revenue processes
• Customer service experience.

Preferred Qualifications:

• Knowledge, understanding of medical account reconciliations and invoicing cycle.
• Certified Professional Coder (CPC)
• Knowledge and understanding of Community Clinic, or FQHC Billing experience.
• Knowledge, understanding and use of Electronic Health/Administrative Records, Resource Patient Management Systems NextGen.

Benefits:

• Supportive and creative work environment.
• Medical coverage offered with two of the region's highest quality providers
• 403B plan with a 3% match after 90 days.
• 12 paid days off.
• Flexible Spending Account
• Paid Time Off (PTO)

Preference in hiring is given to qualified Native Americans in accordance with SNAHC policy. Applicants claiming Indian Preference are required to submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage.

EQUAL OPPORTUNITY EMPLOYER: Within the scope of Indian Preference, all candidates will receive equal consideration without regard to race, color, age, gender, religion, sexual orientation, national origin, medical condition or physical or mental disability, genetic characteristic, pregnancy, marital status, veteran status, or other non-merit factors.

Age Discrimination in Employment Act (ADEA): Sacramento Native American Health Center, Inc. abides by the mandates of the ADEA (protecting individuals 40 years and older) and considers age a non- merit factor in all employment decisions and considerations.

Americans with Disabilities Act (ADA): Sacramento Native American Health Center, Inc. abides by the mandates of the ADA and considers disability a non-merit factor in all employment decisions and considerations. Furthermore, SNAHC will make any practical, feasible, and reasonable arrangements to accommodate qualified applicants and employees with disabilities.

Applicants and employees may request an accommodation of a physical or mental disability at any time in the application process or during employment

Note to Applicants: Please be advised that you may be asked to get a Department of Justice Fingerprinting clearance as a contingency for an offer of employment. Criminal clearances are obtained to protect the welfare and safety of clients receiving services at SNAHC.

As a condition of employment, all Sacramento Native American Health Center employees agree to a Covid-19 vaccination except where otherwise prohibited or where other legal exemption by law is allowed.

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