Medical Biller

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
  
  
  

Benefits/Perks

• Competitive Compensation
• Great Work Environment
• Career Advancement Opportunities
  
  
  

Job Summary

We are currently seeking a detail-oriented and dedicated Medical Biller to join our team. In this role, you will be responsible for managing the billing and collection of outstanding account balances for Medi-Cal and managed care payors . You will analyze and interpret complex payor contract language to calculate expected reimbursements accurately and ensure timely collection of all payments owed to the organization.

Responsibilities

• Process medical billing and follow up on claims with Medi-Cal and managed care payors
• Audit and evaluate clinical documentation and billing records to ensure they are accurate, timely, clinically appropriate, justify medical necessity for Medi-Cal reimbursement, and comply with all State and County documentation and billing requirements.
• Run reports from the designated electronic health record (EHR) to assist program in complying with County and state documentation and billing requirements, perform data validation, and conduct quality control checks.
• Provide oversight and track all billing and coding corrections to ensure accurate and timely billing for designated program/ program staff.
• Interpret and apply complex insurance contract terms to determine appropriate reimbursement
• Work closely with clinical staff, programs and billing department to resolve billing issues and ensure smooth operations.
• Serve as a Medi-Cal billing expert for CRF program staff. Provide consultation and feedback to program management and direct care staff regarding accurate billing and documentation practices.
• Verify patient insurance eligibility and benefits for Medicare and Medi-Cal.
• Provide updates to management on claim billing status, trends and outstanding errors.
• Maintain a high level of confidentiality.
• Review, correct, and submit complex claims with a focus on accuracy, timeliness, and payer-specific requirements.
• Track and analyze denial rates, initiating corrective actions to reduce rejections and improve reimbursement.
• Accurately code and post Medicare Remittance Advice, ensuring complete and compliant documentation.
• Analyze reimbursement trends, payer behavior, and billing performance to identify opportunities for revenue enhancement.
• Deliver actionable insights and strategic recommendations to senior leadership through data-driven reporting.
• Partner with finance and compliance teams to ensure billing data aligns with broader organizational metrics and goals.
• Ensure full adherence to HIPAA, CMS, Medi-Cal, and other payer-specific regulations.
• Serve as a subject matter expert on billing regulations, payer requirements, and industry best practices.
  
  
  

Qualifications

• Experience in Behavioral Health medical billing, particularly with Medi-Cal and managed care
• Strong analytical and problem-solving skills
• Previous experience with medical coding
• Highly detail-oriented and organized
• Knowledge of healthcare billing, payer requirements, and insurance claim processing
• Familiarity with healthcare IT systems, including interfaces and integrations.
• Strong communication and interpersonal skills.
  
  
  

Experience : 3-5 years of experience in a mental health setting, including one year of experience generating reports, data analysis, auditing, and compliance.

Education Required:

• High School diploma or equivalent required