Patients Accounts Billing Representative II

Gateways Hospital and Mental Health Center, located in Los Angeles, is a non-profit organization that provides an array of comprehensive mental health services for Children, Adolescents, Transitional Aged Youth, and Adults suffering from mental illness in the Greater Los Angeles area. The organization consists of a standalone fifty-five (55) )-bed hospital and six outlying outpatient facilities that have anywhere from fourteen (14) beds to one hundred and thirty-four (134) beds. The organization has approximately four hundred (400) employees.

SUMMARY OF POSITION

The Patient Accounts Billing Representative is responsible for accurately and timely submitting claims for all Gateways Hospital and Mental Health Center programs. The position submits electronic data interchange claims, including Medicare, Medi-Cal, commercial insurance, and Drug Medi-Cal claims. The representative ensures compliance with county, state, federal, and payer billing requirements; processes claims; researches and resolves denials; verifies insurance eligibility; maintains billing records; and supports audit and reporting activities. This detail-oriented behavioral health billing professional must have experience with insurance verification, claim batching and submission, denial management, payment posting, and regulatory compliance. The representative collaborates with clinical and administrative teams to maximize reimbursement, reduce billing errors, and maintain applicable billing standards. Proficiency in Excel reporting, key performance indicator tracking, and audit preparation is also expected.

ESSENTIALS DUTIES

• Review billing data for completeness and accuracy; create, validate, and submit clean claims through agency-approved systems, clearinghouses, and payer portals within established filing deadlines.
• Monitor claim denials and payment discrepancies; research, correct and resubmit claims as needed.
• Generate weekly and monthly billing, service delivery and financial reports as requested or needed.
• Work with administrative staff to resolve issues impacting reimbursement.
• Maintain compliance with all regulatory agency requirements and regulations governing submission of claims.
• Participate in audits, site reviews, and quality assurance reviews as requested.
• Review patient account and billing records for required demographic, insurance, authorization, service, and supporting documentation; identify missing or inconsistent information and coordinate timely corrections before claim submission.
• Prepare report binders for accounting at the month end close
• Protect information from unauthorized access, abiding by Gateways’ Code of Confidentiality, HIPAA regulations and other regulatory agencies compliance requirements.
• Attends and participates in meetings, in-service trainings and other meetings as requested.
• Performs other duties as requested, and within scope of practice requirements.

ESSENTIAL SKILLS

• Ability to prioritize competing assignments and meet claim-submission, accounts-receivable follow-up, audit, reporting, and month-end close deadlines.
• Proficiency in Microsoft Office applications, including Excel functions used to organize, validate, reconcile, and report billing and accounts-receivable data.
• Ability to review high-volume, detailed billing information accurately, identify missing or inconsistent data, and maintain complete documentation while meeting productivity standards.
• Ability to use electronic health record, practice-management, clearinghouse, payer-portal, and spreadsheet systems to review accounts, validate claims, submit billing, document follow-up, and research payment activity.
• Ability to safeguard protected health information and confidential financial data, follow access and disclosure controls, and exercise sound judgment when escalating billing, privacy, or compliance concerns.

EDUCATION & CERTIFICATES

• Minimum Education Required: High school diploma or equivalent.

EXPERIENCE/QUALIFICATIONS

• Minimum Experience Required: Two years of healthcare billing experience, including Medi-Cal or Drug Medi-Cal claim submission, denial follow-up, payment research, and application of payer billing requirements.

Preferred Experience and Qualifications:

• Experience using Sage/PCNX or a comparable healthcare billing or patient-account system preferred.
• Working knowledge of current Los Angeles County Department of Mental Health billing, documentation, authorization, and claim-submission requirements.
• Working knowledge of current Drug Medi-Cal billing, documentation, authorization, and claim-submission requirements.

REQUIREMENTS

• Must pass Department of Justice (DOJ), Federal Bureau of Investigations (FBI), and Community Care Licensing (CCL) background clearance.
• Valid California Driver’s license.
• TB clearance.
• Driving record acceptable for coverage by Gateways insurance carrier.

Gateways believes that our people are our greatest asset and is proud to offer competitive benefits that support their health, happiness and career development. 

• Cover 100% Medical/Dental/Vision Premiums for all Full-Time Employees and 1 Dependent 
• 8 Paid Holidays + 4 Personal Holidays in Calendar Year
• 2 Weeks of Vacation
• 403b Retirement Plan Company Match 8%
• Annual Company Events