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Contract Billing Specialist (CPC) - Los Angeles, CA Job in Los Angeles, California

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Job Title: Contract Billing Specialist (CPC) - Los Angeles, CA

Employer:Planned Parenthood Los Angeles
Type:FULL TIME
Skills:revenue cycle,billing,contracts
Specialties:healthcare
Required Certifications:CPC
Required Experience:3 to 4 years
Location: Los Angeles 90007, CA, US
Date Posted:12/4/2020
Planned Parenthood Los Angeles is seeking an experienced Contract Billing Specialist (CPC or CCS) with excellent customer service skills to work full-time in our Downtown Los Angeles Headquarters.  The Contract Billing Specialist is responsible for the implementation and maintenance of payer contracts and payer fee schedules.  Also responsible for the interpretation, translation, and completion of all processes related to maintaining negotiated fees or rates.  In charge of updating any applicable contract files and providing timely responses in regards to any issues raised by payers, clinic operations, and/or the revenue cycle team.

Over one hundred years ago, Planned Parenthood was founded on the idea that everyone should have the information and care they need to live strong, healthy lives and fulfill their dreams. Founded 52+ years ago, Planned Parenthood Los Angeles is one of the largest providers of reproductive health care services in Los Angeles County. The Planned Parenthood Los Angeles (PPLA) team works together to provide high-quality, affordable reproductive health care to women, men, and young people across Los Angeles County. At PPLA, you will discover a culture of like-minded individuals who are eager to make positive contributions to their community and to the Planned Parenthood mission.

Our Ideal Candidate will have the following qualifications:

    • Associate’s degree preferred or an equivalent combination of education and/or experience
    • At least 4 years of experience in Revenue Cycle, preferably Medi-Cal Managed Care required
    • Certified Coder (CPC or CCS)
    • Solid understanding of Contract Lifecycle: Credentialing, Implementation, Renewals, Amendments, Regulations/Compliance, and Assignment
    • Knowledge of health care payment methodologies; Payer contract experience preferred
    • Strong understanding of managed care, delivery systems, and reimbursement
    • Proficient in the Microsoft Office Suite including Intermediate or Advanced Excel skills 

About the position:

    • Create and maintain contract files
    • Interpret internal and external contract documentation such as executed contracts
    • Coordinate with internal departments to execute components of contracts like medical policies
    • Implement updates and additions to the system
    • Aid in the resolution of contractual discrepancies received via avenues like audit reports or reconciliation files
    • Track completed work and request documents from revenue cycle and clinic operations departments
    • Work collaboratively with internal stakeholders to evaluate and monitor contract performance to determine the need for amendments or extensions of contracts
    • Identify, collect, and determine root causes of underpaid claims by auditing payer performance and analyzing actual payments of payers to ensure contract compliance
    • Initiate and follow through with all relevant parties to ensure corrective actions are implemented (i.e., pursue underpayments, adjust expected reimbursement, address billing issues, negotiate settlements, etc.) according to payer specific processes
    • Respond to payment discrepancies by creating appeal letters and articulating contract provisions to representatives from third party payers; work directly with payer to recover payments
    • Generate monthly and ad hoc reports for management as requested
    • Coordinate with other departments to ensure that expected reimbursement rules are up-to-date and accurate
    • Maintain a schedule of key update dates for expected reimbursement rules and yearly increases for contracts
    • Accurately identify payment variances and feed underpayment workflow and resolution
    • Coordinate with plans to resolve issues of contract interpretation affecting rate schedules
    • Ensure new rates for health plan agreements are successfully communicated within the organization
    • Ensure that contracts are properly reviewed, executed, and uploaded into the contract database
    • Ensure that plans are compliant with provider directory locations and attestations, rate loading, and other operational terms in accordance with contract effective date
    • Facilitate the review and submission of credentialing deliverables to payers

Generous salary and benefits package includes:

    • Medical, dental, and vision coverage options for you and eligible dependents
    • Free basic life/AD&D policy with additional voluntary coverage options
    • Short Term Disability, Critical Illness and Accident policies
    • 403(b) Retirement plan with up to 3% employer match
    • Medical and Dependent Flexible Spending Account plans
    • Public Transportation and Commuter Pre-Tax Reimbursements
    • Generous vacation, sick, and holiday benefits
Planned Parenthood Los Angeles is an Equal Employment Opportunity and Affirmative Action Employer.  We will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of Los Angeles County Ordinance No. 184852.

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