Medical Biller/Collections Specialist

Job Description

Job Description

An Ambulatory Surgery Center in Los Angeles is in the need of a Medical Biller/Collections Specialist. This Medical Biller/Collections Specialist is ideal for someone who understands the full revenue cycle and can confidently manage claims, denials, and payer follow-up for surgical services. The right candidate for the Medical Biller/Collections Specialist role will bring healthcare billing experience, strong insurance knowledge, and the ability to keep accounts moving toward timely reimbursement.

Responsibilities:

• Manage end-to-end billing and collections activities for surgical services, from charge review through payment follow-up.

• Confirm patient coverage, authorization details, and payer information using available electronic records and insurance carrier resources before claims are submitted.

• Enter billing data and post charges accurately for surgical cases while maintaining complete and organized account documentation.

• Pursue outstanding third-party balances by conducting regular follow-up with commercial and government payers across multiple plan types.

• Investigate explanation of benefits, identify denial causes, correct claim issues, and resubmit claims to support reimbursement.

• Monitor assigned claim queues and worklists each day to address unresolved accounts, aging items, and billing exceptions in a timely manner.

• Review provider documentation, including urgent care and surgical records, to ensure charges are supported and billing can proceed accurately.

• Apply appropriate diagnosis, procedure, medication, and supply codes based on clinical documentation and operative reports completed by providers.

• Examine aged accounts and unresolved payer responses to resolve denials, appeals, and collection issues efficiently.

• At least 3 years of experience in medical billing and collections within the healthcare industry.
• Hands-on experience with surgical or ambulatory surgery billing, including fee claims management with strong attention to detail.
• Strong understanding of denial resolution, appeals processing, and explanation of benefits review.
• Working knowledge of HMO and PPO plans, payer guidelines, eligibility verification, and authorization review.
• Ability to interpret clinical documentation and assign accurate diagnosis and procedure-related codes for billing purposes.
• Experience managing claim follow-up, aged receivables, and third-party reimbursement issues with strong attention to detail.
• Proficiency with healthcare billing systems, electronic work queues, and insurance portals used for daily account management.