Job DescriptionPosition Medical Biller Collector III – Dental Claims(Denti-Cal Insurance Experience Required)Description The Revenue Cycle Associate III is responsible to work accounts to maximize cash collected. Position also performs a variety of duties which may include answering the in-coming telephone calls, taking down insurance information, verifying eligibility and billing/appealing claims to the insurance company. This position is responsible for handling patient accounts in a high performance, team environment with a number of additional duties as needed for operational needs.Essential Duties of the Position May Include the Following:•Review claims to ensure all key components were submitted accurately to the correct payer.•Reviews correspondence and denial information to determine why claims have not been paid and takes appropriate actions to ensure the accurate and timely submission of claims.•Researches and analyzes accounts and payments to determine whether charges were billed properly, and to resolve incorrect information on patient accounts; reverses balance to credit or debit if charges were improperly billed.•Corrects and resubmits claims and identifies issues that require attention. Makes all the appropriate corrections in the system and submits appeals as appropriate, following individual payer guidelines and including all supporting documentation.•Contacts insurance companies and or patient/Guarantor to verify insurance eligibility and resolve payment problems; provides information to expedite collection process.•Prepares adjustments for charges which cannot be billed and processes or submits to the supervisor per adjustment guidelines.•Ensures authorization, TARs/SARs are included in claim submissions to payers and follows appropriate steps to secure the authorization/retro authorization.•Ability to assist with special projects as needed.•Demonstrates the ability to identify trends that may result in system improvement and or special projects assignments.•Consistently meet/exceed productivity and quality standards.•Assist with training and mentoring new hires or peers.•Effectively work complex and escalated claims.•Cross trained; i.e Pre & Post Authorization Processes, CCS Case pending process, Work multiple worklists across divisions, Inpatient Log Process (high profile workflow as the employee would be trained in CHLA’s STAR system).•Serve as backup to team leadership.•Ability to identify patient concerns and escalate to Leadership and Patient Relations as appropriate.•Ability to identify and/or manage specialized divisional workflow i.e behavioral health charges, ophthalmology charges etc.Requirements Knowledge and skill:1. At least five (5) years Medcial Billing and Collections, Customer Service required. Experience in healthcare customer service, exposure to payer authorization requirements, insurance verification or entry level collector experience preferred.2. Denti-Cal Insurance experience required 3. Orthodontic Billing/AR experience is preferred 4. Dentrix billing systems experience highly preferred 5. Ability to communicate effectively in both written and verbal format with internal and external customers.6. Ability to handle multiple tasks simultaneously.7. Familiarity with payer billing and reimbursement guidelines & regulations, including ability to read and interpret payer Explanation of Benefits (EOB), and Remittance Advice Details (RAD).8. General ICD.10 knowledge.9. Ability to determine correct claim processing related to payer recoupments, overpayments/credits/refunds & underpayments.10. Ability to organize and manage time effectively.11. Handle, in a professional and confidential manner, all correspondence, documentation, and files following HIPAA & PHI guidelines.12. Ability to work independently and as a part of a larger team.13. Microsoft-Word, Outlook & Excel knowledge.14. Highly customer centric position with strong customer service abilities15. Bilingual in Spanish is preferred but not required.Additional Information Hybrid PositionFull-Time, BenefitedDirect Placement#INDH