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.

Summary of essential job duties:

• Flexibility and ability to work in a fast-paced production environment with the capability to manage multiple tasks with a high level of accuracy. Strong interpersonal skills with the ability to work effectively as part of the team.
• Makes recommendations that are based upon transactional review findings as related to best charge practices, documentation practices, as examples.
• Maintains knowledge of all current clinic, dental, optical and hospital billing and coding applications and IT systems that are used by the Business Office.
• Reviews medical record documentation to validate charges and coding related issues.
• Meets defined and established production standards. Work in conjunction with the Director in developing strategies for following up on underperforming payers, initiating process improvement.
• Understanding of the various managed care contracts in place (for each servicing county), to assist with analyzing claims were coded, billed, and adjudicated properly.
• Exercise excellent customer service abilities while interacting with team, internal and external customers while resolving issues.
• Performs daily transactional reviews of La Clinica pre-billing, billed, denied, and disputed charges.
• Discuss patterns of inadequacies related to coding and claims with the Director as they arise.
• Provide usable reports on payers for managed care contract renegotiations to involved La Clinica parties as directed, with the ability to explain deficiencies in coding and payment practices.
• Prepare training materials and conduct internal training as it relates to clinic deficiencies and updates in processes.
• Attend department meetings and trainings as directed.

Required Skills:

• Must demonstrate 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).
• Must have the ability and background in analyzing healthcare data and identifying both problem areas and opportunities for improvement.
• Must be detailed orientated, and able to dissect and analyze large quantities of data and convert it into user friendly reports.
• Familiarity in working with and interpreting contracts and LOA's and MOU's.
• Must be a team player.
• Ability to exercise good judgment in making decisions.
• Ability to work in a timely and efficient manner.
• Ability to work across cultures and demonstrate support of diversity, equity and inclusion.

Required Experience:

• Must have 4-6 years of direct revenue cycle, billing, and Claims experience.
• Previous FQHC experience preferred, not required.