Medical Biller and Claims Processor

TITLE: Medical Biller & Claims ProcessorDEPARTMENT: Finance

REPORTS TO: Director, Finance

LOCATION: 730 Polk Street, San Francisco

BENEFITS: Yes

STATUS: Full-Time, Non-Exempt

CLASSIFICATION: Administrative Support Workers

SUPERVISES: N/A

POSITION SUMMARY:

The Medical Biller and Claims Processor (MBCP) is an exciting opportunity to work at the heart of healthcare and community services integration. The position is responsible for the review and submission of claims for all of Project Open Hand’s Community Support (provided through CalAIM) services. They act as Project Open Hand’s primary financial contact for health plans, implementing and monitoring the billing and collection process. The MBCP also works very closely with Project Open Hand’s Wellness teams in San Francisco & Oakland to pull service reports and resolve claims issues. This position is ideal for someone with knowledge about claims processing for Managed Care Plans in California with an interest in nonprofit financial administration. Project Open Hand is entering its third year of providing Community Support services. As these services continue to expand both with the number of MCPs that we contract with and the number of eligible members of those health plans, we are seeking a team member to help us refine our workflows to maximize reimbursement for the critical services that we provide.

QUALIFICATIONS REQUIRED:

• Experience in business, health care administration, accounting, or a relevant field.
• Solid understanding of HIPAA compliance.
• Must have the ability to multitask and manage time effectively.
• Excellent written and verbal communication skills.
• Outstanding problem-solving and organizational abilities.

QUALIFICATIONS DESIRED:

• Experience with procedural coding (ICD-10 codes).
• Records management.
• Revenue Cycle Representative program and/or the Healthcare Financial Professional program certifications.
• Experience working in CRM database platforms.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Prepares and submits billing data and medical claims to health plans.
• Works closely with Programs team to ensure claims information is accurate and up to date.
• Pulls service reports, prepares bills and submits invoices.
• Records claim payments in MIP Accounting Software.
• Monitors and records late payments.
• Follows up on missed payments and resolves financial discrepancies.
• Investigates and appeals denied claims.
• Prepares and maintains collection reports.
• Works with Health Plans to set up claims submission process and, when necessary, troubleshoots with them on any claim submission issues.

• Establishes standard operating procedures for claims submission and the billing process for each health plan account.

• Maintains contract files and meticulous billing records.
• Works closely with the Programs team to maximize service reimbursement across multiple contracts.
• Supports with additional grant and contract invoicing and reporting as assigned.
• Other duties as assigned.

POH COMPETENCIES/SUCCESS FACTORS:

• A Team player: Demonstrates cooperative spirit, respects professional boundaries and is successful at sharing responsibilities with others
• Self-Led: Knows and completes responsibilities in assigned timelines, asks for clarifications when needed
• Sensitive to the circumstances and needs of the critically ill and seniors, as well as people with mental health and substance abuse issues
• Knowledgeable: Understands facets of job, keeps job knowledge current
• Well Organized: Information organized and accessible, maintains efficient work space, manages time well
• Technical Savvy: Skilled with computers, proficient with function appropriate technology, learns quickly, uses technology to enhance job performance with the interest and ability to learn new technology
• Motivated: Looks for opportunities to increase knowledge, works to increase responsibility, strives to achieve personal goals
• Detail Oriented: Meticulous and thorough when entering, reviewing and providing information

• Open-Minded Collaborator: Understands that worthy goals are achieved through patience and perseverance focusing on the vision rather than the challenges along the way
• Customer oriented: Works well with all customers (internal staff and external contacts), promotes a positive image of the agency and works diligently to resolve customer issues

• Poised: able to maintain a calm, positive and constructive attitude during interactions with diverse populations, sometimes in challenging situations
• Ethical: Honest, accountable, maintains confidentiality
• Decisive: Thoughtful when considering options, seeks input from others, makes difficult decisions when necessary
• Knowledgeable: Understands facets of job, keeps job knowledge current
• Well Organized: Information organized and accessible, maintains efficient work space, manages time well
• A Strong Communicator: excellent verbal and written communication skills
• Technical Savvy: Skilled with computers, proficient with function appropriate technology, learns quickly, uses technology to enhance job performance with the interest and ability to learn new technology

• Leadership I: Completes all assigned tasks in a timely manner and is able to identify projects or work needed for future completion. Anticipates needs before they are assigned. Recognizes themselves as a departmental or function representative

• Takes Initiative: Takes action, seeks new opportunities, strives to see projects to completion
• Problem Solver: Strong analytical skills and able to creatively address and solve problems
• Project Manager: Monitors status of projects, understands project details, holds project owners accountable, delivers clear and accurate feedback
• Detail Oriented: Meticulous and thorough when entering, reviewing and providing information

PHYSICAL DEMANDS AND WORK ENVIRONMENT: The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical demands: While performing duties of job, incumbent is occasionally required to stand; walk; sit for long period of times; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; talk and hear.

Employee must occasionally lift and/or move up to 40 pounds unassisted. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus

Work environment: The noise level in the work environment varies from quiet to loud. The temperature in the work environment will range from cold to warm

Approval/revision date:

I have read and understand the contents of this job description

Signature: Date: