Entry Level Risk Adjustment Coder Jobs in Fremont, CA

The Billing Supervisor I (Back-End Revenue) supports the Revenue Cycle Manager in leading the back-end revenue cycle to achieve organizational goals. This role directly supervises payment posting, claims follow-up, and accounts receivable staff, and is responsible for accurate and timely payment application, denial and rejection follow-up, self-pay account management, AR aging resolution, and month-end closing support. The Billing Supervisor I coordinates closely with the Billing Supervisor II (Front-End Revenue) to ensure clean hand-offs from front-end submission into back-end posting and collections. This position must maintain awareness of the latest requirements of all funded programs, comply with HIPAA guidelines, and maintain confidentiality regarding patient account status and the financial affairs of the clinic or corporation. The Billing Supervisor I reports to the Revenue Cycle Manager and is ranked below the Billing Supervisor II.

ESSENTIAL JOB FUNCTIONS:

Demonstrates a working understanding of Medicare, Medi-Cal, FQHC (Federally Qualified Health Center), state, local programs, and private insurance regulations as they apply to payment posting, follow-up, and AR.
Directly supervises payment posting, follow-up, and AR staff: coordinates daily work activities; organizes, prioritizes, and assigns work; monitors status of work; inspects completed work; troubleshoots problem situations; and assists staff with interpretation of policies/procedures.
Oversees timely and accurate posting of payments, adjustments, ERA/EFT remittances, and ensures unposted and unapplied amounts are resolved promptly.
Manages self-pay receivable accounts: monitors payments; assesses rejections by insurance companies; ensures re-billings as necessary; audits and writes off small-balance accounts receivable for self-pay accounts; sends patient accounts to the collection agency and updates accounts on the website.
Directs accounts receivable follow-up: researches and resolves outstanding claims on aging reports for medical, mental health, optometry, and ancillary services; responds to payer requests and remittance advices through telephone correspondence, letter responses, appeals, and submission of medical records and additional information promptly and professionally.
Works with HIS departments to complete billing inquiries from attorneys or other third parties.
Participates in and supports month-end closing to confirm payments are accurately posted on time.
Reviews unapplied amount reports and accounts receivable credit balance reports and drives their resolution.
Answers patient inquiries and billing complaints by making adjustments as necessary, exercising all options to obtain claim payments, referring patient inquiries to appropriate staff, and ensuring proper follow-up. Handles patient concerns that are unable to be resolved by other staff members.
Acts as a liaison between physicians, insurance companies, and third parties by verifying EOBs, ensuring payments and claims, and reviewing reimbursements on the back end.
Coordinates with the Billing Supervisor II (Front-End Revenue) so that charge, coding, and enrollment issues affecting posting or follow-up are routed and resolved at the source.
Uses the Epic Professional Billing environment for posting and follow-up workflows and reports application issues to the Epic Analyst (who owns system configuration).
Assists the Revenue Cycle Manager in determining probationary and annual evaluations for Billing staff and in the recruiting process for Billing staff.
Trains new employees on payment posting, follow-up, and AR software and workflows, as appropriate.
Generates Epic AR, posting, and collection reports as requested by the Revenue Cycle Manager, CFO, or Administration.
Performs other job duties as required by manager/supervisor.

Completion of a four-year degree from an accredited university.
Four or more years of experience in a medical billing setting, FQHC experience is preferred.
Two or more years of experience leading or training employees.
Epic Resolute Professional Billing (PB) certification is preferred but not required.
Ability to handle responsibility and a demanding work pace.
Must be accountable to handle money and balance finances.
Able to provide excellent customer service and assist in the resolution of disputes.
Understanding of the varying rules and regulations which apply to the healthcare industry, including HIPAA, the False Claims Act, and OSHA compliance.
Familiar with and adheres to CPT, ICD-10 codes, modifiers, and HCPCS Level II coding guidelines as they relate to payment and denial resolution.
Self-motivated, diligent, organized, resourceful, responsible, and enthusiastic.

LANGUAGE:

Must be able to fluently speak, read and write English.
Fluent in Chinese (Cantonese and/or Mandarin) is required.
Fluency in other languages is an asset.

STATUS:

This is an FLSA Exempt position.
This is not an OSHA high-risk position