Insurance Billing Clerk

To be considered for this position, applicants must submit a fully completed application by the posted deadline. Summary: Applicant must possess a high school diploma or equivalent. A diploma or certificate in Medical Coding and Billing is preferred. A current Certified Professional Biller (CPB) certification issued by AAPC is required. The certification must be active and in good standing. A copy of the certification must be submitted with the application. Applicant must have a minimum of two years of experience billing Medicare, Medi-Cal, and Managed Care Plans, including IEHP, Molina, Blue Shield, and Kaiser, as well as FQHC encounter billing. A minimum of two years of experience with medical terminology, ICD-10-CM diagnosis, CPT procedures, and HCPCS codes is required. two years of experience in customer service and medical billing and experience using NextGen Practice Management, Waystar Clearinghouse, and electronic remittance systems is preferred. Two years of experience in customer service and medical billing, as well as experience using NextGen Practice Management, Waystar Clearinghouse, and electronic remittance systems, is preferred. Knowledgeable in insurance billing requirements, including Medicare, Medi-Cal, Managed Care, Commercial insurance, and Tribal FQHC billing. Must have experience with medical terminology, ICD-10-CM, CPT, HCPCS codes, cash/receipt procedures, and interpreting EOBs and ERAs. Candidate must have strong problem-solving, organizational, communication, and computer skills. Experience with practice management software and NextGen EHR is preferred. The Insurance Billing Clerk is responsible for accurately and promptly submitting claims to Medicare, Medi-Cal, commercial insurers, managed care, and other third-party payers. This position ensures claims are submitted correctly, monitors claim status, resolves billing issues, follows up on unpaid claims, and supports 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/appeals management, collections, insurance credentialing, and insurance companies to ensure optimal reimbursement and compliance with all applicable requirements. Must be able to work with the Indian Community, and be sensitive to the 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.