La Clínica de La Raza · 3 hours ago
Billing Specialist, Lead
Oakland, CA
Full-time
Onsite
Mid, Senior Level
$24.79/hr - $32.53/hr
3+ years expLa 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. The Billing Specialist Lead is responsible for the processing and submission of clean, accurate claims to third party payers on behalf of La Clínica.
Health CareHealth DiagnosticsHospitalNon Profit
Responsibilities
Escalates items identified missing information on claims with clinicians to provide accurate, missing information (quantities, codes, etc.) to billers
Understanding of the various managed care contracts in place (for each servicing county), to assist with determining if claims were adjudicated properly
Exercise excellent customer service abilities while interacting with team, internal and external customers while resolving issues
Discuss matters with the Director as they occur related to day-to-day operations of the Business Office
Attend department meetings and trainings as directed
Additional duties as assigned
For outstanding claims identified through Aging Reports, research and re-submit overdue claims/statements within established timeframes
Identify credits, adjustments, and write-offs, providing required documentation for approval of management
Ability to identify errors in the electronic health record as it applies to the claim
Ability to respond to & resolve patient inquiries / discrepancies, submit request for refunds when necessary
Review and resolve payments misapplied, denials and claim rejections; make recommendations for claim edits when necessary
Work in cooperation with Director in initiating process improvement within PFS/Billing department
Provides outstanding service to all providers and fosters teamwork through improvement and innovation
Qualification
Required
Demonstrated 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)
Ability to work across cultures and demonstrate support of diversity, equity and inclusion
ICD-10, CPT Code, and A/R knowledge
Must be able to explain and apply billing policies and procedures for various programs
Must be proficient with Microsoft Word and Excel
Must have a thorough knowledge of working within an EPM/EMR (electronic medical record system)
Must have 3-5 years in a medical environment performing billing or medical accounts receivables functions
Must have experience with billing and collection practices
Preferred
Previous FQHC experience preferred, not required
Benefits
This is a benefited position.
Company
La Clínica de La Raza
Who We Are Since its beginnings as a single storefront operation in Oakland in 1971, La Clínica has grown into a sophisticated provider of primary health care and other services, with 32 sites spread across Alameda, Contra Costa and Solano Counties.
1001-5000 employees
H1B Sponsorship
La Clínica de La Raza has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (1)
2022 (6)
2021 (1)
2020 (3)
Funding
Current Stage
Late StageTotal Funding
$0.04MKey Investors
Blue Shield of California
2025-04-23Grant
2010-08-12Grant· $0.04M
Leadership Team
Jane Garcia
CEO
Anita Juvvadi, MD (she/her)
Deputy Chief Medical Officer
Company data provided by crunchbase