Medical Biller II

PIONEERS MEMORIAL HEALTHCARE DISTRICT•Brawley, CA

About The Position

The Medical Biller II supports the Professional Medical Billing team by posting payments, capturing and working denials, managing outstanding accounts receivable, and performing other assigned duties. The position assists with analyzing and resolving clinic reimbursement issues, reviewing clinical statistics, recommending CDM updates for clinic services, and supporting management with billing responsibilities. It may require minimal supervision from the billing manager and includes assisting Medical Biller 3 with assigned duties. The role requires maintaining follow-up until records are complete and billed, balancing multiple tasks and deadlines, protecting patient confidentiality in accordance with HIPAA, and using EMR systems—including patient accounting and registration systems—to their full capacity. Hours may vary according to departmental needs. The position involves communication with other departments, patients, families, the community, and medical staff. No supervisory responsibilities are assigned.

Requirements

High school graduate or equivalent.
At least one year of experience working with Medicare, Medi-Cal, and insurance.
Knowledge of ICD-10 and CPT-4 coding functions.
Knowledge of medical terminology.
Mathematical ability to review statistical data on financial records.
Experience in data entry using an IBM-compatible computer.
Expertise in electronic and paper systems used in health care billing.
Close attention to detail and excellent problem-solving skills.
Ability to use standard office equipment such as a calculator, copier, and fax machine.
Basic Life Support certification.
Good written and verbal communication skills.
Ability to work varying hours based on departmental needs.

Responsibilities

Post charges and complete claims to payers on time.
Review claims transmitted through the clearinghouse and work rejected claims as needed.
Review patient bills for accuracy and completeness and obtain missing information.
Prepare, review, and transmit claims using billing software, including electronic and paper claims.
Follow up on unpaid claims within the standard billing cycle timeframe.
Check insurance payments for accuracy and compliance with contract discounts.
Contact insurance companies to resolve payment discrepancies when necessary.
Identify and bill secondary or tertiary insurance coverage.
Review accounts for insurance or patient follow-up.
Research and appeal denied claims.
Answer patient and insurance telephone inquiries on assigned accounts.
Update billing software with rate changes.
Read and interpret insurance explanations of benefits (EOBs).
Post ERAs, paper checks, and credit card payments, and balance the lock box.
Provide clinical staff with guidance on insurance, edit, and payer updates.
Assist Medical Biller 3 with assigned duties.
Perform other duties as required and assigned.
Maintain follow-up until records are completed and billed.
Multitask and meet deadlines.
Maintain patient confidentiality in accordance with HIPAA.
Use EMR systems, including patient accounting and registration systems, to their full capacity.
Communicate in writing and verbally with other departments, patients, families, the community, and medical staff.