The billing specialist is responsible for accurate and timely billing for services provided. This role prepares, reviews, and submits claims, resolves denied or unpaid claims, and maintains compliance with local, state, and federal billing regulations. The position works closely with billing, clinical, and agency teams to ensure documentation accuracy, proper reimbursement, and clean claim submission.
Key responsibilities include:
- Reconcile billing records for accuracy, including authorizations, eligibility, diagnoses, and modifiers
- Analyze daily billing reports and flag discrepancies
- Conduct monthly audits of billable claims to ensure compliance
- Submit claims and follow up on outstanding or denied submissions
- Coordinate with agencies regarding reimbursement and documentation concerns
- Partner with the clinical department to verify service documentation
- Maintain admissions tracking for new clients, discharges, and status updates
- Monitor authorization requests and extensions
- Review group counseling and education session logs for billing accuracy
- Use EHR systems such as PCNK and MyEvolv for billing activities
- Stay current on Title 22, Title 9, and DMC Provider Manual guidelines
Requirements & Qualifications
- High school diploma or GED required
- Medical Billing Certificate or equivalent experience preferred
- Minimum of 3 years of hands-on medical billing experience required
- At least 1 year working with SAPC DMC-ODS billing system preferred
- Experience with denied claims handling, auditing, and billing correction
- Knowledge of ICD-10, CPT, and HCPCS coding
- Claims processing and revenue cycle understanding
- EHR/EMR system proficiency
- Microsoft Excel expertise
- Strong organizational and time management skills
- Clear written and verbal communication skills
- Basic math skills
- Team collaboration skills
- Familiarity with DMC procedure codes
Benefits & Perks
- Medical insurance
- Dental insurance
- Vision insurance
- 401(k)
- Growth opportunities
Location
Los Angeles, California, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago