Medical Billing Specialist

Medical Collector / Accounts Receivable RepresentativeAre you in search of a fulfilling and meaningful position? Do you want to work for an organization that promotes growth and development?Here at Men's Health Foundation we envision a world where inequity and stigma do not separate people from healthcare."Reimagining Healthcare" is our commitment to affirming the unique experience of every patient. We prioritize our patients' evolving needs and strive to help each patient feel comfortable, understood, and respected.Why Men's Health Foundation?Men's Health Foundation is seeking compassionate, mission-driven individuals. We believe that by reimagining how healthcare is delivered, we can help create greater health equity for those most at risk, breaking down barriers to care. We welcome all backgrounds, gender identities, and expressions.We recognize our staff as the heart of our organization and seek to provide a generous and competitive benefits package to support our employee's well-being. We offer the following:Medical, Dental, Vision, Life and LTD insurance (may be eligible on the 1st of the month following date of hire)12 Paid Holidays (including 1 mental health day)401(k) Retirement plan (may be eligible for employer matching up to 4% following completion of 90th day of employment)Flexible Spending Account (FSA)40 hours of sick pay (following completion of 90th day of employment)120 hours of PTO accrued within the 1st year of employmentWe seek team members who embrace and champion diversity, as our work within the LGBTQ+ community promotes positive sexuality and inclusivity. Candidates should be comfortable with exposure to imagery, events, and materials that reflect our culture of acceptance and expression, ensuring alignment with our values.Organization Background Men's Health Foundation connects men at risk to comprehensive healthcare and wellness through education, collaboration and advocacy, inspiring and empowering all men to live longer, healthier and happier lives. We see a world where inequity and stigma do not separate men from healthcare.Job Description OverviewThe Medical Collector / Accounts Receivable Representative is responsible for professional provider-side insurance collections, Accounts Receivable (AR) follow-up, denial resolution, reconsiderations, and appeals.The position requires advanced payer knowledge and the ability to independently research and resolve unpaid, underpaid, rejected, and denied claims through final resolution.Essential Functions and ResponsibilitiesManage assigned insurance AR from initial follow-up through final resolution.Follow up on unpaid, underpaid, rejected, and denied professional claims using payer portals, telephone, electronic inquiry, and written correspondence.Prepare and submit corrected claims, claim reconsiderations, first- and second-level appeals, and supporting documentation.Review EOBs/ERAs, claim history, denial codes, authorization requirements, medical necessity, timely filing, and payer-specific billing requirements.Prioritize aged, high-dollar, and deadline-sensitive accounts and maintain follow-up until payment or appropriate final disposition.Document all account activity, payer contacts, reference numbers, actions taken, appeal status, and next follow-up date in the Practice Management system.Identify recurring payer issues and denial trends and escalate significant findings to management.Meet established productivity, quality, collection, and AR reduction expectations while supporting departmental priorities.QualificationsExperience Minimum five (5) years of recent professional/provider-side medical collections and Accounts Receivable experience.Technical Skills Extensive experience with Commercial insurance, Medicare, Medi-Cal/Medicaid, Medicare Advantage, Medi-Cal Managed Care, HMO, PPO, and other third-party payers. Strong hands-on experience with claim reconsiderations, corrected claims, formal appeals, and complex denial resolution.Working knowledge of CMS-1500 claims, CPT, HCPCS, ICD-10-CM, modifiers, Place of Service, NPI/taxonomy, COB, eligibility, authorizations, and timely filing requirements.Ability to interpret EOBs, ERAs, payer correspondence, contractual adjustments, deductibles, copays, and coinsurance.Experience with payer portals, clearinghouses, Practice Management systems, Microsoft Excel, Outlook, and Teams.Skills and Abilities Strong attention to detail and high level of accuracy. Ability to meet productivity and quality standards in a fast-paced environment. Strong analytical and problem-solving skills. Excellent organizational and time management abilities. Ability to work independently and collaboratively. Effective communication skills, both written and verbal. High level of accountability and professionalism. Maintain confidentiality of patient and financial information. Maintain compliance with HIPAA and company policies. Meet or exceed departmental productivity benchmarks. Adheres to company attendance and performance standards.Preferred QualificationsExperience in a physician group, specialty practice, multispecialty organization, or other high-volume professional billing environment. Experience managing AR over 90/120 days, high-dollar claims, payer escalations, denial analysis, and AR cleanup projects. Strong familiarity with California Medicare and Medi-Cal payer requirements.Company RequirementsHigh School Diploma or equivalent. Must be able to pass a pre-employment drug test, physical, and a background check to include a 7-year criminal, 10-year SSN & employer history reference check. Must be able to provide proof of COVID-19 vaccination on the first day of work. Excellent interpersonal skills. Attention to detail. Must be able to work flexible schedules. Must take yearly flu shot or wear flu mask during flu season for patient-facing positions and test for tuberculosis as required by the Centers for Disease Control and Prevention.