Call Processing Reimbursement Specialist 1 (Hybrid)

$45,968 - $58,989/Yr

San Ysidro Health Center - San Diego, CA

Full-time - Entry Level

Hybrid - San Diego, CA

11-50 employees

Ambulatory Health Care Services

About the position

The Call Processing Reimbursement Specialist I is a vital role within San Ysidro Health, responsible for managing the complete revenue cycle, which includes billing for medical, dental, and hospital claims. This position requires direct interaction with members over the phone, ensuring that all insurance balances are followed up on to guarantee accurate and timely reimbursement. The specialist will also handle self-pay collections after insurance and address any billing-related inquiries from patients. In this role, the specialist must demonstrate a thorough understanding of San Ysidro Health's services and programs to effectively assist callers. Responsibilities include reviewing and updating patient demographics, providing excellent customer service, and efficiently managing calls. The specialist will need to recognize and address unique medical issues, urgent services, and patient grievances, following established protocols for resolution or escalation to a supervisor. The position requires logging in to receive or make calls as per the schedule, utilizing break codes as defined by the call management system. The specialist will prepare accounts for billing accuracy, transmit claims using both automated systems and manual processes, and ensure that all necessary attachments are provided to third-party claims. Additionally, the role involves calculating disallowances and adjustments based on various reimbursement schedules and performing timely follow-ups on unpaid claims. The specialist must maintain assigned Accounts Receivable at or below the set goal consistently and compose professional correspondence with internal and external entities. The Call Processing Reimbursement Specialist I will also participate in meetings and training sessions as required and may be called upon to assist with special projects or audits, which could involve evening or weekend hours. Adherence to departmental policies, quality assurance programs, and safety standards is essential.

Responsibilities

• Manage the complete revenue cycle including billing for medical, dental, and hospital claims.
• Follow up on insurance balances to ensure accurate and timely reimbursement.
• Handle self-pay collections after insurance and answer billing-related questions.
• Demonstrate knowledge of San Ysidro Health services to assist callers effectively.
• Review, collect, and update patient demographics as necessary.
• Provide excellent customer service by greeting, listening, assisting, and directing calls appropriately.
• Recognize and effectively handle unique medical issues and patient grievances.
• Log in and be ready to receive or make calls as per the schedule.
• Communicate clearly and effectively with patients and staff via calls or electronic messages.
• Prepare, review, and transmit claims using automated systems and manual processes.
• Provide required attachments to third-party claims to ensure timely payment.
• Identify and bill secondary payers as needed.
• Calculate disallowances and adjustments based on reimbursement schedules.
• Perform timely follow-ups and appeals on unpaid claims using system work lists and payment documents.
• Document all findings, phone calls, and correspondence in the practice management system.
• Maintain assigned Accounts Receivable at or below goal consistently.
• Compose professional written correspondence with internal and external entities.
• Attend meetings and training classes as required.
• Participate in special projects and internal/external audits.

Requirements

• Minimum of 1 year experience in a medical billing department.
• Knowledge of CPT, HCPCs, and ICD-10 coding as well as medical terminology.
• High School Diploma or GED equivalent.
• Good oral and written communication skills in English.
• Experience in billing, CPT codes, and ICD-10.
• Ability to work independently and manage time effectively.
• Experience with Microsoft Office software.

Nice-to-haves

• Experience in customer service roles.
• Familiarity with medical terminology and coding systems.

Benefits

• Competitive hourly wage between $22.10 - $28.36.
• Hybrid work model allowing for remote work every other week.
• Opportunities for professional development and training.