Insurance Billing Clerk

To be eligible for consideration, a fully completed application must be received by the posted deadline. A complete application includes all required sections, including education, employment history, references, and any other information or documents requested in the job posting. Applications that are incomplete or completed after the posted deadline will not be eligible for consideration.

Summary:

Applicants must possess a high school diploma or equivalent and a Diploma in Medical Coding and Billing. Certification as a Certified Professional Biller (CPB) is required at the time of hire or must be obtained within one (1) year of employment. A minimum of two years of experience is required in medical billing, including billing Medicare, Medi-Cal, Managed Care Plans, Commercial insurance, and FQHC encounters. Applicants must also have at least two years of experience with medical terminology, ICD-10-CM diagnosis codes, CPT procedures, HCPCS codes, and interpreting EOBs and ERAs. Experience with NextGen Practice Management, NextGen EHR, Waystar Clearinghouse, electronic remittance systems, customer service, cash/receipt procedures, and Tribal FQHC billing is preferred. Candidates must demonstrate strong problem-solving, organizational, communication, and computer skills. Current CPR/BLS Provider certification through the American Heart Association (AHA) or the American Red Cross is required. If not currently certified, certification may be obtained prior to orientation and must be completed within ninety (90) days of employment. The Insurance Billing Clerk is responsible for the accurate and timely submission of claims to Medicare, Medi-Cal, commercial insurers, managed care plans, and other third-party payers. Duties include monitoring claim status, resolving billing issues, following up on unpaid claims, and supporting revenue cycle performance while maintaining compliance with payer, federal, state, and organizational requirements. The position works closely with providers, coding staff, patient registration, payment posting, denials and appeals, collections, credentialing, and insurance companies to help ensure accurate reimbursement. Must be able to work effectively with the Indian Community and be sensitive to Indian culture and its needs.

Major Duties and Responsibilities:

• Utilize the Practice Management (PM) system to review, edit, and submit claims accurately and in a timely manner through Waystar or the designated clearinghouse.
• Monitor claim edits, rejections, and clearinghouse reports. Promptly correct and resubmit rejected claims, and follow up on unpaid, denied, or underpaid claims.
• Correct demographic, coding, insurance, and billing errors identified in Waystar edits.
• Reconcile claims transmitted through the clearing house with claims accepted by payers.
• Review electronic remittance advice (ERA) and claim status reports.
• Utilize Waystar claim status and eligibility tools to research claim issues.
• Escalate recurring clearinghouse or payer issues to revenue cycle leadership.
• Assist with implementation of payer-specific billing requirements and clearinghouse updates.
• Monitor timely filing deadlines and resubmit corrected claims as necessary.
• Contact insurance companies regarding claim status and reimbursement issues, and document all account activities in the billing system.
• Analyze denials to identify root causes, submit corrected claims and appeals with supporting documentation, maintain denial-tracking logs, and assist with denial reduction efforts.
• Work assigned aging reports, monitor timely filing deadlines, assist with collections and account resolution, and escalate complex reimbursement issues as needed.
• Maintain productivity and quality standards established by the Revenue Cycle Department.
• Support process improvement initiatives to reduce denials and increase cash collections.
• Maintain compliance with HIPAA and patient confidentiality requirements.
• Follow Medicare, Medi-Cal, managed care, and commercial payer billing regulations.
• Report billing errors, compliance concerns, or potential overpayments, and maintain accurate records of billing activities.
• Respond professionally to patient and payer inquiries, and assist patients with billing and insurance questions.
• Communicate effectively with internal departments regarding claims issues.
• Review the diagnosis and the procedures. Ensure that claims have appropriate provider, provider number, billing address and coding to match FQHC Guidelines for Medicare and Medi-Cal claims processing.
• Submit all secondary insurance (i.e., Medi-Cal and group insurance) on medical claims with remittance advice attached.
• Adjust accounts as needed in system (i.e. no insurance coverage, services not covered) under the guidance of the revenue cycle lead.
• Responsible for maintaining a consistent attendance record and free of tardiness. Quantity and quality expectations of work based on full time equivalent.
• Self-development – Attend any insurance seminars or staff meetings as needed.
• This position requires working weekends and evenings, if needed.
• Other duties as assigned relevant to the position, with relevant training and competency assessment documented
• Prepare, review, and submit paper claims to insurance carriers, ensuring accuracy, completeness, and compliance with payer requirements.

Qualifications

Education:                           

High school diploma or equivalent and a Diploma in Medical Coding and Billing are required.

Experience:

• Two years of experience billing Medicare, Medi-Cal, Managed Care Plans, including IEHP, Molina, Blue Shield, and Kaiser, and FQHC encounters is required.
• Two years of experience with medical terminology, ICD-10-CM diagnosis codes, CPT procedures, and HCPCS codes is also required. Experience working with Tribal FQHCs or Community Health Centers is preferred but not required.
• Two years of customer service and medical billing experience, as well as experience using NextGen Practice Management, Waystar Clearinghouse, and electronic remittance systems, is preferred but not required.

Certification: 

Certified Professional Biller (CPB) required at time of hire or obtained within one (1) year of employment.

CPR (BLS Provider) certification through the American Heart Association (AHA) or the American Red Cross. Certification may be obtained prior to orientation. Certification may obtained within 90 days of employment.

Knowledge of:         

Knowledge of Insurance companies requirements. The incumbent must also be knowledgeable about the unique differences between rural and primary billing as it relates to Medi-Cal billing. Must also be familiar with Cash Flow concepts and cash/receipt procedures. Proficient in medical terminology, basic ICD-10-CM diagnosis, CPT procedures, and HCPCS Codes. Experienced with Medicare, Medi-Cal, Managed Care, and Commercial insurance, and Tribal FQHC billing requirements. Skill in interpreting explanation of benefits (EOBs) and Electronic Remittance Advice (ERAs).

Skill:               

Demonstrates excellent problem-solving, strong attention to detail, and effective organizational skills. Communicates effectively both verbally and in writing to convey and receive information. Experience with practice management software/NextGen EHR preferred. Must demonstrate ability to organize work in a logical manner. Proficient in the use of computers and software, including but not limited to practice management software, word processing, and spreadsheet applications. Must understand or be willing to receive Native American cultural competency training and employ cultural awareness with our Native American community.

Ability to:       

Maintain strict confidentiality procedures. Can consistently meet productivity and accuracy goals. Ability to multi-task and meet tight deadlines. Works well with others, supports coworkers, shares knowledge, and helps achieve team and company goals by collaborating with both internal and external partners. Maintains professional relationships, helps create a positive and respectful workplace, and delivers excellent customer service and strong results.

Must be able to work with the Indian Community, and be sensitive to the Indian culture and its needs.
 

Physical Demands:

The work is mostly sedentary. However, the employee must be able to carry items weighing up to 25 pounds. The work is normally performed in an office setting. Dexterity of hands with coordination of eye and hand movement.

Schedule:

Monday-Thursday 7:00am-4:00pm, Friday 7:00am-1:00pm

Remote Work Eligibility:

This position may be eligible for a hybrid work schedule after the new hire successfully completes their introductory period. Hybrid work eligibility is subject to supervisor approval, position requirements, and organizational needs.

Appointment Type: 

Full-Time, Non-Exempt

Compensation:

$22.00–$23.00 per hour ($45,760–$47,840 annually, depending on experience and internal equity) 

Clinic Location: 

San Manuel Indian Health Clinic (11980 Mt. Vernon Ave. Grand Terrance Ca, 92313)