JOB PURPOSE: Position is responsible for identification and evaluation of billing contracts to ensure accurate reimbursement as well as additional opportunities for revenue enhancement. Works closely with billing staff and third party payers related to contract rates and disputed claims.

JOB FUNCTIONS:
• Identifies CCFMG’s billing contracts and contract rates for reimbursement.
• Evaluates and recommends proposed new billing contracts.
• Monitors contracts and communicates trends in reimbursement; provides recommendation from revenue enhancement.
• Develops and maintains CCFMG’s contract database.
• Maintains reimbursement reference files.
• Reviews and resolves claims not meeting contract reimbursement rates.
• Identifies and recommends other potential revenue opportunities.
• Performs other special projects/assignments needed to support the organization.

JOB QUALIFICATIONS

Education:
• Bachelor’s degree or equivalent combination of education and related work experience.

Experience:
• Minimum four years related work experience, preferably in a medical or hospital setting.

PERFORMANCE REQUIREMENTS:

Knowledge:
• Knowledge of government and commercial medical plan insurance regulations and requirements.
• Knowledge of health care insurance claim practices and compliance.

Skills:
• Excellent computer skills to include MS Word, Excel, and Access database software applications.
• Excellent verbal and written communication skills and customer service skills.

Abilities:
• Ability to apply principles of analytical thinking to evaluate data and make appropriate recommendations.
• Ability to understand and interpret policies and regulations.
• Ability to handle confidential data including patient protected health information, payer fee schedule and reimbursement rates.

Equipment Operated:
• Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment:
• Position in a well lighted office environment. Frequent contract with a variety of people.

Physical Requirements:
• Involves sitting approximately 90 percent of the day, walking or standing the remainder. Some bending, stooping, and lifting up to 15 pounds.

• Location: Fresno, CA
• Compensation: DOE plus benefits
• Principals only. Recruiters, please don’t contact this job poster.
• Please, no phone calls about this job!
• Please do not contact job poster about other services, products or commercial interests.