Overview
This role involves managing accounts receivable follow-up, denial management, and payment posting to maximize reimbursement and ensure timely resolution of outstanding claims. The focus is primarily on Alameda Alliance, Medicare, and Medi-Cal claims. The position also supports training of front desk staff, new hires, and interns as needed, and reports directly to the Billing Manager.
Responsibilities
- Review paper and electronic remittance advices (ERAs), explanation of benefits (EOBs), and denial notices.
- Post insurance payments and contractual adjustments accurately using AdvancedMD.
- Conduct accounts receivable follow-up on billed claims to ensure timely payment.
- Research denied or underpaid claims and take corrective action toward resolution.
- Correct claim errors and resubmit claims to payers as appropriate.
- Investigate payment delays and unresolved claims to maximize reimbursement.
- Review and update patient demographics, insurance plans, and carrier information.
- Verify insurance eligibility and primary care provider (PCP) assignment when necessary.
- Maintain accurate demographic and insurance information in the electronic health record and billing system.
- Monitor and report denial trends and reimbursement issues to the Billing Manager.
- Participate in internal chart audits, billing audits, and compliance activities.
- Implement payer billing guidelines, policies, and procedures.
- Support front desk training, including development of tip sheets and desk references for the Patient Services Department.
- Assist with onboarding and training of new hires and interns as needed.
- Attend staff meetings, supervision sessions, and required trainings.
- Complete assigned documentation and reports in a timely manner.
- Perform other related duties as assigned.
Requirements
- High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
- Minimum of three (3) years of experience in medical billing, payment posting, or accounts receivable follow-up.
- Experience working with Medicare, Medi-Cal, and managed care payers, including Alameda Alliance for Health.
- Strong knowledge of insurance denials, appeals, and payer billing guidelines.
- Proficiency in Electronic Health Records and practice management systems, preferably AdvancedMD.
- Knowledge of medical terminology and healthcare reimbursement principles.
- Strong analytical, organizational, and problem-solving skills.
- Ability to train and support staff in registration and billing-related workflows.
- Experience working in a nonprofit or community health center setting preferred.