Medical Claims Processor

West Hollywood, CA

OUR PURPOSE

 

Men’s Health Foundation connects men at risk to comprehensive healthcare and wellness through education, collaboration and advocacy, inspiring and empowering all men to live longer, healthier and happier lives.  We see a world where inequity and stigma do not separate men from healthcare.  At Men’s Health Foundation we are reimagining men’s healthcare.

THE POSITION

Reporting to the Revenue Cycle Manager, the Claims Processor will process charges as part of the billing function within the organization's established policies. Performs billing and claims processing functions for the various service components of the clinics, assists other claims processors as needed; serves as back up for the Billing Manager and runs various financial reports as needed by the CFO. Consistently utilizes and facilitates effective strategies to communicate pertinent information in a timely manner.

 

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: (This list may not include all of the duties assigned.)

 

 

  • Codes such items as invoices, vouchers, expense reports, check requests, etc., with correct codes conforming to standard procedures to ensure proper entry into Allscripts.

  • Uses critical thinking skills to interpret information furnished in written, oral, diagram, or schedule form and to follow complex dental processes

  • Makes sound decisions and sets goals based on available information and evaluates situations and requirements to plan and adjust work accordingly.

  • Projects accurate future occurrences based on current or historic data.

  • Strong math skills to add, subtract, multiply and divide as well as work with fractions and percentages accurately.

  • Handles all patient requests via phone or email.

  • Prepares non-inventory purchase order requisitions.

  • Investigates and resolves problems associated with processing of charges.

  • Prepares batch reconciliation reports.

  • Assists with monthly status reports, and monthly closings.

  • Reconciles various accounts by identifying errors in posting or omissions by applying appropriate billing standards

  • Process remittance information from checks, drafts and wire transfers for invoices provided by payers, reviewing instructions accompanying items to determine proper payments in accounts in accordance with standard procedures.

  • Receives, researches and resolves a variety of routine internal and external inquiries concerning account status, including communicating the resolution of discrepancies to appropriate persons.

  • Ensures efficiency, accuracy and accountability of information and data. 

  • Performs claims processing functions in a timely and accurate manner.

  • Checks “superbills” for accuracy prior to entering into the system.

  • Reviews and, as necessary, corrects data entry and billing errors prior to transmission.

  • Bills payment source(s) within 48 hours of patient’s visit.

  • Posts payment checks to appropriate accounts.

  • Researches payment denials and re-submit for payment as necessary.

  • Checks count of “superbills” against daily log to ensure that every patient’s visit related paperwork has been received, posted and billed

  • Prepares month end reports.  

  • Looks up CPT and ICD-10 codes for accurate coding.

  • Performs weekly transmission of claims.

  • Updates daily error reports for clinic/nurse managers.

  • Other duties assigned, as required. 

QUALIFICATIONS:

  • Associate degree (A. A.) or equivalent from two-year college or technical school;
  • Two to three years related experience and/or training; or equivalent combination of education and experience.
  • Proficient in MS Word and Excel Software and tech savvy.

REQUIREMENTS:

  • Maintains highest degree of confidentiality in donor, staff, client, fiscal and organizational matters; understands and meets HIPAA, OSHA and infection control requirements.

  • Remains up to date on best practices relevant to the position; enhances personal skills.

  • Completes continuing education as required to retain licensure or certificates and cooperates with credentialing requirements and requests.

  • Provides courteous and timely assistance to internal and external customers.

  • Meets time and attendance requirements for the position and uses work hours productively and appropriately.

  • Follows procedures and policies in completing work and making decisions.

  • Completes continuing education as required to retain licensure or certificates and cooperates with credentialing requirements and requests.

  • Meets criminal background search clearance.

 



COMPANY REQUIREMENTS:  

  • Must be able to pass a background check to include a 7-year criminal, 10-year SSN & employer history reference check, as well as successfully pass a pre-employment drug test.  
  • Excellent interpersonal skills
  • Attention to detail
  • Must take yearly flu shot and test for tuberculosis as required by the Centers for Disease Control and Prevention.