Billing & Collections Representative II

Under the direction of the Manager, Professional Billing & Coding, the Billing & Collections Representative II is responsible for resolving outstanding balances from all payors, including Commercial, Medi-Cal, and Managed Care professional claims.

This role reviews unpaid claims by phone, web portals, and other available methods; gathers required documentation from payors to support accurate claim adjudication; processes claims according to contractual arrangements; analyzes denials using patient account details, EOBs, and remittance advice; reviews coding edits; and submits corrected claims or appeals when appropriate.

The position also tracks problematic payor trends, documents account activity in the patient financial record, reviews clearinghouse rejections, and follows federal, state, local, department, and payor-specific billing and collection guidelines.