Billing Care Coordinator in Orange at Prospect Medical Systems

Date Posted: 7/31/2020

Job Snapshot

  • Employee Type:
  • Location:
    600 City Parkway West
  • Experience:
    Not Specified
  • Date Posted:
  • Job ID:

Job Description

Billing Care Coordinator, Care@Home Program

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

Care@Home is a home-based patient care program that provides health care services in the comfort and convenience of the patient’s home.  It’s like an old-fashioned house-call for patients who are eligible to join.  The program provides medical care, social support, and help with nutrition and medications.

The Billing Care Coordinator is responsible for the timely submission of technical or professional medical claims to insurance companies. They are also responsible for managing and coordinating high quality, evidenced based care to complex and high-risk patients with the primary goal and objectives of providing best-in-class patient care, reducing avoidable hospitalizations, and decreasing unnecessary emergency department utilization.

As a member of the program care team, the Billing Care Coordinator, is responsible for managing and coordinating care for a panel of high-risk patients. This individual will facilitate appointments for the member, which include Health Plan and Prospect’s programs as related to their diagnosis, Rounding Provider, NP, Dietitian, Pharmacist, Specialist, and appointments and transportation if needed.

The Billing Care Coordinator is required to maintain patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Job Responsibilities/Duties

  • Responsible for submitting medical claims to insurance companies and payers.
  • Review, analyze and code diagnostic and procedural information that determines Medicare, MediCal, HMO and Private insurance payments.
  • Post daily claim encounters and maintain internal control for timely claims submission.
  • Check eligibility and benefits verification for treatments, hospitalizations and procedures as needed.
  • Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
  • Answer incoming phone calls from patients, clinicians, care-givers, vendors, etc.  Provide support to Care@Home clinical staff.
  • Communicate, by phone, in person, in writing or electronically with Care@Home team, PCPs, Specialists, vendors, patients and/or patient’s caregiver in order to provide comprehensive care or to make referrals, as necessary.
  • Submit referrals into the appropriate claims system, authorization system. Maintain turn-around-time compliance with all referrals.
  • Generate letters, faxes, calls to PCP and patients along with resources.
  • Document all calls and complete tasks, open and close cases for new and termed members in Care Management system.
  • Obtain medical records for Care@Home patients, upload to EMR and Care Management systems and send to the Care Team.
  • May be required to travel to patient homes and provide interpretation or assistance to Care@Home Providers.
  • Schedule appointments for new patients, explain program to patients, families and caregivers.
  • Add new patient demographics to EMR Practice Management system.
  • Participate in patient education regarding urgent care, advance directives, palliative care, hospice, flu vaccination and other issues related to Chronic Care management.


Minimum Education: High School diploma or Associate degree required. Medical Assistant (MA) preferred.

Minimum Experience: One to two years (1- 2) years clinic billing experience preferred. Understands and remains updated with current coding and billing regulations and compliance requirements. Experience in patient care/medical office preferred. Electronic Medical Records experience preferred. Some knowledge of managed care and healthcare required. Proficient in MS Office programs (i.e., Word, Excel, Outlook) and type 60 wpm. Bi-lingual Spanish preferred. Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems required. Familiarity with CPT, ICD-10, and HCC coding. Effective written and verbal communication skills. Demonstrated ability to be self-directed, and motivated. Must be able to drive, have driver’s license, auto insurance coverage and car that can be used to travel locally for work. Willingness to address issues and take ownership, knowing when and how to escalate issues. Good computer skills with demonstrated proficiency in Microsoft Office applications. Detail oriented with good analytical and organizational skills. Comfortable in a fast-paced environment with the ability to multitask concurrent priorities in an organized manner.

Req. Certification/Licensure: None. Medical billing certificate preferred.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

How to Apply

To apply for this role, or search our other openings, please visit and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law:

Keywords: Medical Claims, Insurance, Healthcare, Hospitals, CPT, ICD-10, HCC Coding, MA, Medical Billing, Patient Care, Microsoft Word, EMR, HMO, PPO, Medicare, Medicaid, Clinics, compliance, regulations, managed care.