Medical Biller

Job Summary:
The Outpatient Medical Billing Specialist is responsible for accurately processing and submitting claims for outpatient services within a large health system. This role ensures compliance with payer guidelines, resolves claim denials, and coordinates with internal departments to optimize reimbursement. The ideal candidate has a strong understanding of medical billing, insurance follow-up, and revenue cycle processes in a high-volume healthcare environment.

Key Responsibilities:

Prepare, review, and submit claims for outpatient services to commercial and government payers.
Verify insurance coverage and ensure proper coding and charge capture for accurate claim submission.
Research and resolve claim denials, rejections, and underpayments in a timely manner.
Follow up on outstanding claims to maximize reimbursement and minimize aging accounts receivable.
Communicate with insurance companies, patients, and internal departments to resolve billing inquiries.
Maintain compliance with payer policies, federal and state regulations, and health system procedures.
Assist with account reconciliation, refunds, and adjustments as needed.
Utilize electronic health record (EHR) and billing systems to track claim status and documentation.
Generate and review reports to monitor billing performance and identify trends.
Provide support for audits, appeals, and revenue cycle initiatives.
Qualifications:

High school diploma or equivalent required; associate's or bachelor's degree in healthcare administration, business, or a related field preferred.
Minimum of 2 years of experience in medical billing, preferably in an outpatient setting within a large health system.
Strong knowledge of CPT, HCPCS, ICD-10 coding, and payer billing guidelines.
Experience with electronic claims submission and medical billing software.
Familiarity with Medicare, Medicaid, and commercial insurance regulations.
Excellent problem-solving and communication skills.
Ability to manage multiple tasks in a fast-paced environment and meet deadlines.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.