Who we are: La Clínica de La Raza is a community-based health center committed to providing culturally appropriate, high-quality, and accessible health care to the diverse communities of the San Francisco Bay Area. We have spent over 40 years advocating for and creating a health home for the many that have been denied access to care. As health care activists, we are dedicated to making sure individuals who do not have health coverage get the same level of quality healthcare as those who have it. From our genesis as a community health center in 1971, we understood that we cannot heal our communities without also addressing the economic and social factors that affect health. Many times, this requires that we go outside and provide services in other settings to build the bridge that links individuals to our health center for preventive and primary care. Over 90,000 individuals come to La Clínica because it is a welcoming place that addresses the whole person, coordinating and connecting them to a broad network of services to improve and maintain their health and well-being. While we are still known for our activism and spirit of social justice, we are also proud to have grown into a sophisticated provider of primary health care services with 35 sites across Alameda, Contra Costa, and Solano counties.

About the position: The Billing specialist Lead is responsible for the processing and submission of clean, accurate claims (across all service lines, e.g., medical, dental, vision, etc.) to third party payers on behalf of La Clinica

Major Areas of Responsibility include but are not limited to:

• Escalates items identified missing information on claims with clinicians to provide accurate, missing information (quantities, codes, etc.) to billers.
• Understanding of the various managed care contracts in place (for each servicing county), to assist with determining if claims were adjudicated properly.
• Exercise excellent customer service abilities while interacting with team, internal and external customers while resolving issues.
• Discuss matters with the Director as they occur related to day-to-day operations of the Business Office.
• Attend department meetings and trainings as directed.
• Additional duties as assigned.
• For outstanding claims identified through Aging Reports, research and re-submit overdue claims/statements within established timeframes.
• Identify credits, adjustments, and write-offs, providing required documentation for approval of management.
• Ability to work across cultures and demonstrate support of diversity, equity and inclusion.
• Ability to identify errors in the electronic health record as it applies to the claim.
• Ability to respond to & resolve patient inquiries / discrepancies, submit request for refunds when necessary.
• Review and resolve payments misapplied, denials and claim rejections; make recommendations for claim edits when necessary.
• Work in cooperation with Director in initiating process improvement within PFS/Billing department.
• Provides outstanding service to all providers and fosters teamwork through improvement and innovation.

Requirements, Knowledge:

• Demonstrated knowledge and experience with third party reimbursement programs, and the ability to identify problems with payers (e.g., Medicare, Medi-Cal, and other third-party carriers).
• ICD-10, CPT Code, and A/R knowledge.
• Must be able to explain and apply billing policies and procedures for various programs.
• Must be proficient with Microsoft Word and Excel.
• Must have a thorough knowledge of working within an EPM/EMR (electronic medical record system).

Other Certifications and Experience

• Must have 3-5 years in a medical environment performing billing or medical accounts receivables functions. Previous FQHC experience preferred, not required.
• Must have experience with billing and collection practices.