Medical Billing Specialist

Medical Billing Specialist, DMEPOS Unicare Health | Newbury Park, CA (Onsite) About Unicare Founded in 1988, Unicare Health helps patients with complex medical needs thrive at home through compassionate care, expert clinical support, and trusted partnership with families and healthcare providers. We are a leading, innovative provider of home respiratory care, durable medical equipment, and home medical supplies, poised for high growth. We don't just deliver machines; we deliver life-sustaining care and services. Our vision is to empower complex respiratory patients to live their most full, joyful, comfortable, and active lives possible. Our guiding principle is simple: serious care delivered with compassion. Our revenue cycle team is central to that mission, ensuring accurate, timely reimbursement so clinicians and families can stay focused on care. What We Stand For Relentless pursuit of improved outcomes. We proactively solve problems, move quickly, and collaborate so every patient achieves the best possible clinical and quality-of-life results. Serious care delivered with compassion. We combine clinical rigor and high standards with empathy, warmth, and respect in every interaction. Patients and families first. Every decision is guided by what will most support the comfort, confidence, and daily lives of the people we serve. Experience matters as much as equipment. We deliver not only advanced technology, but also education, responsiveness, and ongoing support that make care easier at home. Position Summary We are seeking a highly experienced, detail-oriented, and professional individual to join our team as a Medical Billing Specialist with DMEPOS expertise. This role is critical to our financial health and operational success, ensuring that our life-sustaining respiratory and DME services are accurately coded, billed, and reimbursed. You will own claims from submission through resolution, managing payment posting, secondary and tertiary billing, patient billing, AR, denials, and appeals with accuracy and compliance in every action. This is a foundational hire. As one of the first members of our revenue cycle team, you will report directly to the Vice President of Revenue Cycle Management and Compliance and work side by side with senior leadership to build the function from the ground up. For a high performer, this is a rare opportunity to grow into a functional leadership role as the team and organization scale. This is a full-time, onsite role based in our Newbury Park office. Teammates work a standard 8-hour day plus lunch and are expected onsite during core office hours of Monday through Friday, 9:00 AM to 4:00 PM PST. How the Role Works This role owns claims submission and the full back end of the DMEPOS revenue cycle: clean claim submission, payment posting and reconciliation, secondary and tertiary billing, patient billing, AR management, and denials and appeals. You work in close partnership with the intake and qualification function, which feeds you clean, billable documentation, and you close the loop by surfacing denial and underpayment trends back to the front end for prevention. As Unicare scales, strong performers in this role have a clear path to depth and leadership within the billing and AR function. Key Responsibilities Claims Submission Prepare, review, and submit clean paper and electronic claims to government and commercial payers, with particular emphasis on California Medicaid ( Medi-Cal ). Translate clinical documentation, inventory and ICD-10 diagnoses into accurate, billable HCPCS codes for respiratory, DME, and supply items where required for billing. Manage clearinghouse edits, errors, and rejections, correcting and resubmitting claims promptly to prevent delays. Partner with the intake and qualification function to confirm claims are fully documented and billable before submission. Payment Resolution and Denials Management Process and post paper and electronic remittances (ERA/EOB) and patient payments accurately. Reconcile posted payments against expected reimbursement and deposits, resolving variances. Post denials and zero-pays, coding them correctly so denial trends can be tracked and worked. Coordinate secondary and tertiary billing, submitting claims to downstream payers with correct primary remittance (COB) information once the primary adjudicates. Manage patient billing, generating and sending statements for balances after insurance and responding to patient inquiries with professionalism and sensitivity to family circumstances. Coordinate delinquent accounts with third-party collection agencies per company policy. Work aging reports to keep AR days within target, prioritizing high-value and aging claims and escalating systemic payer issues. Research and resolve denials, short-pays, and underpayments, identifying root cause and correcting for resubmission. Prepare and file timely appeals with supporting documentation, tracking through to resolution. Perform administrative and contractual adjustments accurately and within defined authority levels, maintaining clean and reconciled account balances. Own overall AR integrity, keeping patient and payer balances accurate so financial reporting reflects true collectible revenue. Identify denial and underpayment trends and surface them to leadership and to the intake function to drive front-end prevention. Across the Function Handle patient escalation calls to the office with strong customer service, protecting the patient and family experience at every touchpoint. Maintain accurate patient and claim records in the billing system. Coordinate with intake, documentation and clinical teams to close gaps that affect reimbursement. Work fluently in a technology-driven, automation-heavy environment, adopting billing platforms, clearinghouses, EMR/EHR systems, and workflow tools quickly and using them to work efficiently at scale. Ensure billing practices comply with payer rules, CMS DMEPOS requirements and applicable regulations. Qualifications Required 2+ years of DMEPOS medical billing experience across claims submission, payment posting, secondary/tertiary billing, patient billing, and denials/appeals. Hands-on experience billing home respiratory therapies, including ventilators, oxygen therapy, CPAP, and BiPAP, and the documentation and billing requirements each carries. Experience billing California Medicaid ( Medi-Cal ), Medicare, and commercial payers; strong Medi-Cal DMEPOS experience is a top priority. Demonstrated experience billing home medical supplies and recurring supply drops, not solely capital equipment such as ventilators; supply-side fluency (resupply cadence, consumables, HCPCS for supplies) is essential. Working knowledge of how DMEPOS documentation and ICD-10 diagnoses map to billable HCPCS codes and modifiers; formal medical coding certification is not required, what matters is practical DMEPOS billing fluency. Patient-friendly customer service skills are critical; this role carries a meaningful volume of inbound and outbound patient and family calls, including escalations, and requires warmth, patience, and professionalism on every one. A strong coordinator and team player who works closely with intake, clinical, and delivery colleagues so mission-aligned care is delivered and reimbursed without gaps. Proficiency with the Microsoft Office suite (Outlook, Word, Excel) and a fundamental understanding of how EMR/EHR, order management and billing systems work together. Tech-savvy and comfortable in an automation-forward operation, with the aptitude to learn new systems fast and improve how work gets done rather than relying on manual process. Uncompromising integrity, with a commitment to HIPAA compliance and to preventing fraud, waste, and abuse in every claim and account action. Able to work full-time and onsite in Newbury Park, covering a standard 8-hour day plus lunch and present during core office hours of Monday through Friday, 9:00 AM to 4:00 PM PST. Strong attention to detail, follow-through, and ownership. Preferred Bilingual in English and Spanish, given the families we serve. Pediatric and/or home respiratory (oxygen, PAP, ventilator, nebulizer) billing experience. Experience building or tracking revenue cycle metrics and reporting to leadership. Experience in a high-growth or ground-floor environment. California Home Medical Device Retailer (HMDR) Exemptee certificate. Compliance and Integrity Unicare operates in a highly regulated space, and integrity is non-negotiable. We expect every member of the revenue cycle team to operate with honesty and to hold themselves to the highest ethical standard in every claim, adjustment, and patient interaction. In this role you will safeguard protected health information in full compliance with HIPAA, and you will actively help prevent fraud, waste, and abuse across all billing and account activity. You will ensure that all billing, coding, adjustments, and account work comply with CMS DMEPOS requirements, payer rules and applicable state and federal regulations. Administrative and contractual adjustments are performed within defined authority levels, and all activity is documented accurately to support a clean, auditable revenue cycle. What We Offer You will join a collaborative, mission-driven environment where your work directly supports families caring for medically complex patients. We put patients and families first and pursue improved outcomes relentlessly, and we look for team members who bring that same standard to their work. As a foundational hire, you will have real ownership, direct access to senior leadership and a clear path to grow with the company. Benefits Medical, dental and vision coverage Retirement plan Competitive paid time off (PTO) Competitive compensation [range to be added] Unicare Health is an equal opportunity employer. [Add standard EEO statement per company policy.] #J-18808-Ljbffr Unicare Health Services