Under the direct supervision of the Health Center Operations Director, the Medical Biller I/II supports the revenue cycle by preparing, submitting, and following up on medical claims for services rendered within a health center setting. The role ensures timely reimbursement while maintaining compliance with payer guidelines, FQHC billing requirements, and organizational policies.
The Medical Biller I works collaboratively with clinical and administrative teams to resolve billing issues and support continuity of care. The Medical Biller II performs more advanced revenue cycle functions, including complex claim resolution, denial management, and process improvement.
Key responsibilities include:
- Prepare, review, and submit accurate claims to Medi-Cal, Medicare, and commercial payers
- Review patient accounts for completeness, including insurance verification, coding, and required documentation
- Monitor claim status and follow up on unpaid, denied, or rejected claims
- Resolve billing discrepancies, including eligibility issues and authorization requirements
- Post payments, adjustments, and denials accurately into the practice management system
- Assist with patient statements and billing inquiries
- Maintain knowledge of FQHC billing requirements, including PPS and wrap-around payments
- Ensure compliance with federal, state, and payer-specific billing regulations
- Communicate with front office and clinical staff to correct or clarify billing information
- Maintain accurate billing records for audit and compliance purposes
- Support month-end close processes and reporting as needed
- Participate in safety programming and maintain professional conduct
Medical Biller I
- High school diploma or equivalent required
- One year of medical billing experience in a healthcare setting preferred, ideally within a community health center or FQHC environment
- Basic knowledge of CPT, ICD-10, and HCPCS coding
- Familiarity with Medi-Cal, Medicare, and managed care plans preferred
- Experience with electronic health records and practice management systems highly desirable
- Ability to maintain confidentiality and comply with HIPAA regulations
- Must have a valid California driver’s license and liability insurance if driving on business
Medical Biller II
- High school diploma or equivalent required
- Minimum of four years of progressively responsible medical billing experience in a healthcare setting required, preferably within a community health center or FQHC environment
- Strong knowledge of CPT, ICD-10, and HCPCS coding
- Familiarity with Medi-Cal, Medicare, and managed care billing required
- Experience with electronic health records and practice management systems highly desirable
- Ability to maintain confidentiality and comply with HIPAA regulations
Core competencies
- Strong attention to detail and accuracy in data entry and claim submission
- Ability to manage multiple tasks and meet deadlines in a fast-paced environment
- Effective communication and problem-solving skills
- Strong analytical skills and ability to identify trends and implement solutions
- Team-oriented with a customer service mindset
Location
California, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
2 weeks ago