Commercial and Bay Surgery Center (BSC) Billing Specialist (Hybrid)

Job Description

Job Description

POSITION SUMMARY

The Commercial & Bay Surgery Center (BSC) Billing Specialist is responsible for the accurate and timely billing, follow-up, appeals, and collections of commercial and facility-based claims for Pain & Rehabilitative Consultants Medical Group (PRCMG) and Bay Surgery Center (BSC). This position plays a critical role in revenue cycle operations by ensuring proper reimbursement, resolving denials and underpayments, managing aging accounts, and maintaining compliance with federal, state, and payer-specific billing regulations. The ideal candidate is highly detail-oriented, experienced in high-volume commercial and facility billing, and demonstrates strong analytical, organizational, and communication skills.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Billing & Claims Processing

Prepare, review, and submit accurate commercial and facility claims for physician and Ambulatory Surgery Center (ASC) services.

Review claims for completeness and accuracy; correct errors prior to submission.

Ensure compliance with payer guidelines and contractual requirements.

Post and reconcile insurance and patient payments accurately.

Denials, Appeals & Reimbursement

Review Explanation of Benefits (EOBs) for denials, underpayments, and down-coded services.

Prepare and submit appeals with appropriate documentation and supporting evidence.

Follow up with payers regarding unresolved claims and pending appeals.

Identify trends in denials or underpayments and escalate issues as appropriate.

Accounts Receivable & Aging Management

Review aging reports and prioritize follow-up on outstanding balances.

Initiate collection activity for overdue accounts in accordance with policy.

Communicate with patients regarding balances, payment arrangements, and billing inquiries.

Present accounts to the Billing Manager for lien, collection agency referral, or bad debt determination as necessary.

Workers’ Compensation & Regulatory Compliance

Submit Second Bill Review (SBR) appeals for underpaid or denied Workers’ Compensation claims when applicable.

File liens and required documentation in accordance with California Workers’ Compensation regulations when assigned.

Maintain working knowledge of California billing regulations, payer requirements, and fee schedules.

Communication & Collaboration

Respond professionally to incoming telephone calls and billing inquiries.

Provide outstanding customer service to patients, payers, and internal staff.

Collaborate with the Billing Manager and revenue cycle team on special projects and process improvements.

Attend department meetings and participate in ongoing education and training.

Maintain confidentiality of patient and financial information in accordance with HIPAA regulations.

Perform other duties and assignments as directed.

Qualifications Required (Education, Experience, AND Skills)

High School Diploma or GED required

Minimum three (3) years of recent medical billing and collections experience in a healthcare setting

Experience with commercial payer billing and facility (ASC) claims

Demonstrated experience managing denials, appeals, and accounts receivable follow-up

Experience working in a high-volume medical practice environment

Working knowledge of medical terminology

Knowledge of ICD-10, CPT, and HCPCS coding

Understanding of commercial, PPO, and HMO billing regulations and guidelines

Strong ability to interpret Explanation of Benefits (EOBs)

Proficiency in billing software systems

Proficiency in Microsoft Office (Word and Excel)

Strong attention to detail and accuracy

Excellent time management and organizational skills

Ability to meet deadlines in a fast-paced environment

Strong written and verbal communication skills

Ability to work independently and collaboratively

Professional, calm, and customer-focused demeanor

PREFERRED

Experience with Work Comp, Commercial, HMO, PPO or Ambulatory Surgery Center (ASC) facility billing.

Workers’ Compensation billing and appeals experience

Knowledge of California Official Medical Fee Schedule (OMFS) regulations

Experience filing liens and managing regulatory submissions

Meditab IMS billing software experience

Certified Professional Coder (CPC) certification

Advanced Excel skills for reporting and aging analysis

Experience in a multi-specialty or pain management practice

Pain & Rehabilitative Consultants Medical Group (PRCMG) is a leading Northern California practice providing comprehensive, evidence-based pain management and rehabilitative care through a multidisciplinary team dedicated to improving function and quality of life.

Company Description

Pain & Rehabilitative Consultants Medical Group (PRCMG) is a leading Northern California practice providing comprehensive, evidence-based pain management and rehabilitative care through a multidisciplinary team dedicated to improving function and quality of life.