Medical Billing Clerk

Overview

Founded in 1970, East Valley Community Health Center is a Federally Qualified Health Center (FQHC) whose services include providing personalized, affordable, high‑quality medical, dental, vision and behavioral health care through a community‑based network within the East San Gabriel Valley and Pomona Communities. Our staff practices patient‑centered care by serving each patient with a personalized care plan that meets their individual needs.

Patients have access to support services that include nutrition, health education, case management, pharmacy, lab, and x‑ray at our health center locations. East Valley serves the health care needs of uninsured and underserved individuals and families throughout our eight health center locations.

Our mission is to provide access to excellent health care while engaging and empowering our patients, employees, and partners to improve their well‑being and the health of our communities.

Under direct supervision of the Revenue Cycle Manager, the Billing Clerk is responsible for accurate billing of all outpatient services, procedures, diagnoses and conditions, working from the appropriate documentation in the Electronic Medical Record. The candidate will review that claims correspond to appropriate classification systems including ICD‑10‑CM, CPT, Healthcare Common Procedure Coding System (HCPCS) and other specialty systems as required by diagnostic category.

All work is carried out in accordance with the rules, regulations and coding conventions of ICD‑10, Centers for Medicare and Medicaid Services (CMS), Office of Statewide Health Planning and Development (OSHPD), government contractual requirements, third‑party insurance and EVCHC coding guidelines. Billing Clerks will be responsible for payment posting, assigned collections, and face‑to‑face customer services. They will manage assigned Work Edit Que's and run hard‑copy paper claims as necessary.

• Review patient chart documentation to ensure correct coding and accurate billing; process and enter accurate data into Nex Gen in a timely manner.
• Submit claims, edit errors, and troubleshoot paper and/or electronic claim submissions per carrier requirements in a timely manner; clear errors per carrier receipt and resubmit.
• Assist patients by answering questions regarding individual statements.
• Research unpaid claim status daily and troubleshoot to reduce accounts receivable balances.
• Work daily on various work queues (Charge Review, Claim Edit, Follow‑Up).
• Post payments to the system associated with patients and insurance carrier remittance.
• Prepare and process refunds to patients and insurance carriers.
• Serve as a mentor to staff, developing a positive team atmosphere within the department.
• Meet or exceed customer needs in a caring, effective and efficient manner.
• Maintain quality levels that meet or exceed customer expectations through process improvement and a team‑oriented approach.
• Perform other duties or projects as assigned.

• HS Diploma or GED. Completion of classes in medical terminology, anatomy and physiology, ICD‑10 and Current Procedural Terminology (CPT) coding conventions, and disease process from an accredited program.
• At least two (2) years of billing experience in a private or health‑care organization (preferred but not required); experience with physician or ambulatory setting coding preferred. Medi Cal knowledge is a plus.
• Strong computer skills and working knowledge of Microsoft Word and Excel.
• Ability to use health‑related practice management system.
• Ability and willingness to demonstrate and maintain competency as required for the job title.
• Good organizational and communication skills.
• Bilingual (English and Spanish) highly preferred.
• Ability to multi‑task and consistently meet deadlines.
• Must be detail oriented and accurate.

East Valley offers a defined contribution retirement plan and you will also enjoy work‑life balance with paid time off and paid holidays throughout the year.

Medical Billing Clerk
• Pomona, CA, United States

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