Billing Representative

Under the direct supervision of the Sr. Manager Billing/Revenue Cycle with fiscal oversight from the Finance and Accounting department, the Billing Representative is responsible for the full cycle of processing and maintenance of all third party and self-pay billing generated by Tiburcio Vasquez Health Center (TVHC). The position is integral to the centralized billing team responsible for Medicare, Medi-Cal, Private Insurance, Managed Care, and other third-party billing and collections for all TVHC providers and facilities. The Billing Representative also provides analytical support to establish and achieve revenue cycle goals and objectives. Using industry guidelines and best practice standards, the Billing Representative supports optimization of department performance in a variety of areas, including, but not limited to, and claims submission and adjudication and follow-up on outstanding receivables and denials. Using standard and ad hoc reporting, the Billing Representative identifies opportunities for improvement and procedural enhancement. As a collaborative position, the Billing Representative must work together with physicians, medical assistance, front desk staff, and Finance and IT staff (and staff from other departments) to ensure the timeliness and accuracy of billing. This is a full-time benefited position working 40 hours per week, typically Monday through Friday with periodic Saturday hours. We offer excellent benefits including: medical, dental, vision (including dependent and domestic partner coverage), generous paid leave benefits including holidays, Flexible Spending Accounts, retirement plan with an Employer match, tuition reimbursement, monthly treats, pet insurance and more. Tiburcio Vasquez Health Center is a non-profit community health center that is dedicated to promoting the health and well-being of our community by providing accessible, high quality care by integrating primary care, dental care, WIC support, mental health counseling, community health education and more. Compensation: $23.00 - $27.88 per hour, depending on experience. TVHC offers compensation ranges that are determined by a thorough market-based analysis and are fully disclosed in accordance with California law. The pay for a selected candidate is determined by a variety of factors to ensure fair and equitable compensation. These factors include the candidate's experience, education, skills, training, licensure, certifications, and the specific scope of the role. We are committed to providing a competitive compensation package that extends beyond base salary, designed to support the health, wealth, and career development of our employees. Responsibilities: Establishes, maintains and updates patient accounts in accordance with TVHC policies and procedures. Works interdependently with the Finance and Accounting department to maximize patient billing under all forms of acceptable insurance reimbursement and self-pay. Responsible for the timely follow up on denied Remittance Advice/Explanation of Benefits (RA/EOB) for all insurance claims. Develop well-supported, patient specific appeal arguments to submit to payers, where an appeal is warranted (e.g. medical necessity, prior authorization). Communicates regularly with the management staff, as appropriate, to ensure the smooth and efficient workflow and processes throughout the Health Centers. Maintains current knowledge of billing practices, procedure codes, and patient insurances. Enlists the assistance of the Chief Financial Officer and/or her/his designee in questions of compliance, “red flag” activity, proper handling of cash receivables, and other matters involving fiscal responsibility in patient accounts. Monitors workflow for multiple sites to accomplish timely billing cycles, submitting all records on a monthly schedule without fail and without compromise to accuracy. Observes highest degree of confidentiality protocols to prevent compromise of patient records. Provides superior customer service to all patients and takes a solutions-oriented approach to all complaints related to patient billing issues. Ensures patient records' integrity, including daily computer data back-up. Demonstrates ability to meet or exceed Service Excellence Standards of TVHC, Inc. Performs other duties as assigned. The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and expectations required of the position. Requirements Bilingual in English and Spanish required. Two years medical practice billing experience; medical practice front-end experience and understanding preferred. Must have excellent oral and written communication skills. Must have advanced analytical skills, including data analysis and procedure review. Proficiency with Microsoft Office applications, particularly Excel, Word and PowerPoint. Report production and presentation skills. Excellent interpersonal skills. Highly developed customer service skills. Ability to relate well to physicians, other front office administrators, staff, and billing management. Experience with EPIC Electronic Billing, and EHR in an FQHC environment preferred Education and Experience High school graduate or equivalent required Associates degree in accounting or related field highly preferred. Coding and billing courses completed preferred. Experience with EPM/EMR software systems preferably EPIC 1+ Years Accounts Receivable experience including Billing, Reconciliations, and Collections. Intermediate level MS Excel, Ten-Key by touch, must be detail oriented, decipher contract language, and compute billing adjustments manually. Benefits This is a full-time benefited position working 40 hours per week, typically Monday through Friday with periodic Saturday hours. We offer excellent benefits including: medical, dental, vision (including dependent and domestic partner coverage), generous paid leave benefits including holidays, Flexible Spending Accounts, retirement plan with an Employer match, tuition reimbursement, monthly treats, pet insurance and more.