Medical Billing Specialist

Job Description

Job Description

We are looking for an experienced Medical Billing Specialist to join a healthcare organization in California. This Medical Billing Specialist opportunity is ideal for someone with a strong background in surgical and ambulatory facility billing who can support accurate claim processing and healthy revenue cycle performance. The Medical Billing Specialist will work closely with payers, patients, and internal teams to resolve billing issues, improve reimbursement outcomes, and maintain compliant account documentation.

Responsibilities:

• Prepare and submit facility claims for surgical services with careful attention to completeness, accuracy, and payer-specific rules.

• Review procedure details, patient information, coverage data, and required authorizations before releasing claims for billing.

• Apply appropriate coding elements, including diagnosis and procedure codes, modifiers, and revenue details, to support proper reimbursement.

• Enter and reconcile insurance payments, patient payments, adjustments, and other account activity in a timely manner.

• Analyze remittance documents and explanation of benefits statements to identify denials, short payments, and billing variances.

• Pursue outstanding receivables by contacting payers, researching account status, and escalating issues affecting reimbursement.

• Investigate rejected claims and denial trends, then prepare corrected submissions, reconsiderations, or appeals when needed.

• Monitor aging reports and organize follow-up efforts based on deadlines, claim value, and collection priorities.

• Communicate with insurance representatives, physician offices, patients, and internal departments to address account questions and resolve discrepancies.

• Maintain complete billing records while following healthcare privacy standards and current reimbursement regulations.

• At least 2 years of medical billing experience, preferably in an ambulatory surgery center or other surgical care setting.
• Working knowledge of facility billing workflows and core revenue cycle functions.
• Experience billing commercial plans, Medicare, Medicaid, workers’ compensation, and other third-party payers.
• Familiarity with diagnosis and procedure coding, modifiers, revenue codes, and standard medical claim documentation.
• Demonstrated success in denial resolution, accounts receivable follow-up, and medical collections.
• Ability to interpret EOBs, ERAs, and payer correspondence accurately.
• Proficiency with medical billing platforms, electronic payer portals, EPACES, and Microsoft Office.
• Strong organizational, communication, and problem-solving skills in a fast-paced environment.