Medical Biller

Job Summary:

The Medical Biller will be responsible for managing and processing patient billing for a multi-specialty clinic, including primary care, urgent care, and pain management services. The individual will handle insurance claims, patient billing, and reimbursement processes while ensuring compliance with relevant regulations. This role requires attention to detail, strong communication skills, and experience with medical billing software.

Key Responsibilities:

• Insurance Billing and Claims:
• Submit claims for services provided in primary care, urgent care, and pain management to private insurers, Medicare, and Medicaid.
• Verify patient insurance eligibility and benefits prior to treatment.
• Process insurance rejections and denials, and work on resolving discrepancies.
• Handle follow-up with insurance providers regarding unpaid or delayed claims.
• Patient Billing and Collections:
• Generate and send out patient statements for services rendered.
• Manage patient payment plans and collect payments in person, over the phone, or through the clinic’s online portal.
• Answer patient billing inquiries and resolve payment issues.
• Coding and Documentation:
• Ensure accurate coding of diagnoses, procedures, and treatments using ICD-10, CPT, and HCPCS codes.
• Work closely with providers to clarify documentation when needed for correct billing.
• Stay updated on coding changes for primary care, urgent care, and pain management services.
• Compliance and Regulatory Adherence:
• Ensure compliance with federal and state billing regulations, including HIPAA.
• Monitor compliance with insurance payer contracts.
• Ensure proper handling of sensitive patient data and billing information.
• Reporting and Analysis:
• Generate reports on billing productivity, claim status, and account receivables.
• Assist in month-end closing procedures and reconciliation of accounts.

Required Skills and Qualifications:

• High school diploma or GED required; associate degree in healthcare administration or related field preferred.
• Experience: 2 years of medical billing experience, preferably in a multi-specialty clinic (primary care, urgent care, pain management).
• Certification: Certified Professional Biller (CPB) or Certified Medical Reimbursement Specialist (CMRS) preferred.
• Knowledge of Billing Software: Experience with billing software such as eClinicalWorks, Kareo, or PrognoCIS.
• Coding Proficiency: Knowledge of ICD-10, CPT, and HCPCS coding.
• Excellent communication and customer service skills.
• Strong problem-solving abilities and attention to detail.

Preferred Qualifications:

• Familiarity with electronic health record (EHR) systems.
• Knowledge of insurance payer policies and medical necessity guidelines.

Job Type: Full-time

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• Weekends as needed

License/Certification:

• Medical Billing Certification (Required)

Ability to Relocate:

• Bakersfield, CA 93312: Relocate before starting work (Required)

Work Location: In person