Reporting to the Revenue Cycle Manager, the Medical Biller II is responsible for billing and collection activities for the clinic’s primary care, pediatric, behavioral health, and dental services. This role works closely with providers, front office staff, and the Quality Improvement Department.
Key responsibilities include:
- Reviewing insurance information, financial classification, and eligibility prior to claim submission
- Understanding billing requirements for Medi-Cal, Newborn Gateway, CPE, PE4PP, Family PACT, Medicare, commercial insurance plans, and dental programs
- Applying the Sliding Fee Discount Program and resolving discrepancies with Revenue Cycle Management
- Ensuring claims are complete and ready for submission, including accurate charges, authorization/certification information, demographics, and insurance details
- Submitting claims electronically or on paper using IHCFA 1500 and UB04 forms
- Following up on encounter data submissions to health plans, IPAs, and other payers
- Communicating with providers, patients, payers, and staff regarding billing inquiries
- Analyzing patient accounts, generating monthly statements, and reconciling daily collections
- Posting payments, charges, and adjustments to patient accounts
- Correcting, rebilling, or adjusting denials in a timely manner
- Reviewing EOBs and taking appropriate follow-up actions
- Maintaining HIPAA compliance and payer-specific guidelines
- Supporting month-end billing close activities
Requirements & Qualifications
Must have:
- 2–3 years of direct medical billing experience
- Experience with an electronic health record system; eClinicalWorks experience preferred
- Understanding of CPT, CDT, HCPCS, and ICD-10 coding protocols
- Knowledge of Medi-Cal, Medicare, managed care, and private insurance billing requirements related to FQHCs
- Bilingual fluency in English and Spanish
- Proficiency with Microsoft Office, including intermediate Excel skills
- Strong accuracy, analytical, problem-solving, time management, and organizational skills
- Ability to communicate effectively with providers, staff, and outside vendors
- Ability to work collaboratively, prioritize effectively, and maintain confidentiality
- High school diploma or GED
Preferred:
- Certified Professional Coder (CPC) and/or Certified Professional Biller (CPB)
Location
California, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
2 weeks ago
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