Medical Billing Specialist

Medical Billing Specialist

Eastridge Workforce Solutions is committed to connecting skilled professionals with meaningful career opportunities. We are seeking a Medical Billing Specialist to support a Revenue Cycle Management team in Carlsbad, CA. This position is responsible for preparing and reviewing medical claims for Durable Medical Equipment (DME/DMEPOS), orthotic, and prosthetic devices, including insurance verification, authorizations, documentation review, claim submission, and basic denial resolution. The ideal candidate has recent medical billing experience, strong attention to detail, and the ability to work efficiently in a fast-paced healthcare environment.

Essential Functions

Prepare and review DME/DMEPOS claims for accuracy and completeness.

Verify patient eligibility, insurance benefits, and payer information.

Obtain authorizations and pre-authorizations as required.

Review documentation and obtain missing information prior to claim submission.

Utilize insurance carrier portals to research eligibility and claim information.

Partner with Health Information Management (HIM) to support clean claim submissions.

Submit and resubmit claims to insurance carriers as necessary.

Identify basic denial reasons and escalate complex billing or payer issues.

Respond to questions from patients, insurance companies, and internal teams.

Follow established billing procedures and payer guidelines.

Meet established claim-processing, accuracy, and productivity expectations.

Qualifications

Previous medical billing or healthcare revenue cycle experience required.

DME/DMEPOS, orthotics, prosthetics, or similar medical billing experience preferred.

Experience with insurance eligibility, benefits verification, and authorizations.

Familiarity with insurance carrier portals and claim submission processes.

Knowledge of ICD-10, medical terminology, basic anatomy, and orthopedic diagnoses preferred.

Understanding of medical claims, denials, and payer requirements.

Strong computer and data-entry skills.

Excellent attention to detail, organization, and follow-through.

Ability to manage multiple priorities in a high-volume environment.

Must be able to work fully onsite in Carlsbad, CA.