Medical Biller

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
  
  
  

Benefits/Perks

• Competitive Compensation
• Great Work Environment
• Career Advancement Opportunities
  
  
  

Job Summary

We are currently seeking a detail-oriented and dedicated Medical Biller to join our team. In this role, you will be responsible for managing the billing and collection of outstanding account balances for Medi-Cal and managed care payors. You will analyze and interpret complex payor contract language to calculate expected reimbursements accurately and ensure timely collection of all payments owed to the organization.

Responsibilities

• Process medical billing and follow up on claims with Medi-Cal and managed care payors
• Audit and evaluate clinical documentation and billing records to ensure they are accurate, timely, clinically appropriate, justify medical necessity for Medi-Cal reimbursement, and comply with all State and County documentation and billing requirements.
• Run reports from the designated electronic health record (EHR) to assist program in complying with County and state documentation and billing requirements, perform data validation, and conduct quality control checks.
• Provide oversight and track all billing and coding corrections to ensure accurate and timely billing for designated program/ program staff.
• Interpret and apply complex insurance contract terms to determine appropriate reimbursement
• Work closely with clinical staff, programs and billing department to resolve billing issues and ensure smooth operations.
• Serve as a Medi-Cal billing expert for CRF program staff. Provide consultation and feedback to program management and direct care staff regarding accurate billing and documentation practices.
• Verify patient insurance eligibility and benefits for Medicare and Medi-Cal.
• Provide updates to management on claim billing status, trends and outstanding errors.
• Maintain a high level of confidentiality.
• Review, correct, and submit complex claims with a focus on accuracy, timeliness, and payer-specific requirements.
• Track and analyze denial rates, initiating corrective actions to reduce rejections and improve reimbursement.
• Accurately code and post Medicare Remittance Advice, ensuring complete and compliant documentation.
• Analyze reimbursement trends, payer behavior, and billing performance to identify opportunities for revenue enhancement.
• Deliver actionable insights and strategic recommendations to senior leadership through data-driven reporting.
• Partner with finance and compliance teams to ensure billing data aligns with broader organizational metrics and goals.
• Ensure full adherence to HIPAA, CMS, Medi-Cal, and other payer-specific regulations.
• Serve as a subject matter expert on billing regulations, payer requirements, and industry best practices.
  
  
  

Qualifications

• Experience in Behavioral Health medical billing, particularly with Medi-Cal and managed care
• Strong analytical and problem-solving skills
• Previous experience with medical coding
• Highly detail-oriented and organized
• Knowledge of healthcare billing, payer requirements, and insurance claim processing
• Familiarity with healthcare IT systems, including interfaces and integrations.
• Strong communication and interpersonal skills.
  
  
  

Experience: 3-5 years of experience in a mental health setting, including one year of experience generating reports, data analysis, auditing, and compliance.

Education Required:

• High School diploma or equivalent required