Medical Billing Specialist

Qualifications: High school diploma or equivalent One to two years of medical billing experience preferred; experience in a healthcare clinic or federally qualified health center (FQHC) is a plus Knowledge of medical billing procedures, insurance claims submission, payment posting, denials management, and accounts receivable follow-up Familiarity with commercial insurance, Medicare, Medi-Cal, and other government healthcare programs - Knowledge of managed care contracts, legal requirements, and fee schedules may be required - Knowledge of PPOs, Medicare, Medi-Cal, and state programs such as CPSP, FPACT, and EWC - Must possess knowledge of ICD-10, CPT, HCPCS - Medical terminology and an understanding of HIPAA privacy law - Proficiency with electronic health records, practice management systems, and Microsoft Office applications - Ability to manage competing priorities, meet deadlines, and work collaboratively with clinical and administrative teams. - Medical billing certification (such as Certified Professional Biller CPB) preferred but not required - Working knowledge of Epic preferred - Bilingual preferred Essential Responsibilities: - Review and verify patient demographics, insurance coverage, billing information, and supporting documentation for accurate claims submission - Prepare, submit, and track electronic and paper insurance claims, including CMS-1500 and UBs-04 forms - Review medical records and billing codes for accuracy, completeness, and compliance with payer requirements - Post insurance payments, patient payments, charges, contractual adjustments, and denials accurately - Review remittance advice and explanations of benefits to identify payment discrepancies and determine appropriate follow-up - Investigate and resolve rejected, denied, and underpaid claims; submit corrected claims and appeals as appropriate - Monitor accounts receivable, maintain accurate billing records, and follow up on outstanding claims and unpaid balances - Review and complete assigned billing work queues daily to support timely claims processing and resolution - Communicate with insurance payers, patients, and internal departments to resolve billing questions and discrepancies - Assist patients with billing inquiries and establish payment plans in accordance with organizational policies - Prepare and review accounts receivable reports and identify trends affecting reimbursement - Maintain patient confidentiality and comply with HIPAA, payer requirements, and applicable billing regulations - Stay informed of changes to billing guidelines, insurance policies, coding requirements, and reimbursement procedures - Identify opportunities to improve billing workflows, reduce claim denials, and support efficient revenue cycle operations. - Perform other related duties as assigned. Current Basic Life Support (BLS) certification #J-18808-Ljbffr Harmony Health Medical Clinic & Family Resource Center