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

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 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. 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 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. #J-18808-Ljbffr Energy Jobline ZR