Medical Biller II

PIONEERS MEMORIAL HEALTHCARE DISTRICT•Brawley, CA

9d•$25 - $29

About The Position

This position supports the Professional Medical Billing team by posting payments, capturing and working denials, managing outstanding accounts receivable balances, and performing other assigned duties. The role assists with analysis and resolution of clinic reimbursement issues, clinical statistics, recommendations for CDM updates for clinic services, and other billing responsibilities assigned by management. The Medical Biller II prepares and processes claims, follows up on unpaid and denied claims, reviews payment accuracy, communicates with patients and insurers, and provides guidance to clinical staff about insurance, edit, and payer updates. The position uses billing software and EMR systems, including patient accounting and registration systems, and may require minimal supervision from the billing manager. It requires flexibility with varying hours based on departmental needs, attention to detail, problem-solving, and effective written and verbal communication. The role requires a high school diploma or equivalent, experience working with Medicare, Medi-Cal, and insurance, knowledge of ICD-10 and CPT-4 coding and medical terminology, data-entry experience, and familiarity with electronic and paper healthcare billing systems. Basic Life Support certification is required. The position has no supervisory responsibilities and does not provide patient care.

Requirements

High school graduate or equivalent.
At least one to years of experience working with Medicare, Medi-Cal, and insurance (as written in the posting).
Knowledge of ICD-10 and CPT-4 coding functions.
Knowledge of medical terminology.
Mathematical ability to review statistical data on financial records.
Data-entry experience using an IBM-compatible computer.
Expertise in electronic and paper systems used in healthcare 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.
Ability to travel between training locations and within communities.
Ability to sit for extended periods, stoop and bend, and use hands and fingers to operate a computer keyboard, mouse, power tools, and other computer components.
Some lifting of more than 50 pounds may be required.

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 processing.
Follow up on unpaid claims within standard billing cycle timeframes.
Check insurance payments for accuracy and compliance with contract discounts.
Contact insurance companies to address payment discrepancies when necessary.
Identify and bill secondary or tertiary insurance.
Review accounts for insurance or patient follow-up.
Research and appeal denied claims.
Answer patient and insurance telephone inquiries about 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 lockbox.
Provide clinical staff with guidance on insurance updates, edit updates, and payer updates.
Assist Medical Biller 3 with assigned duties.
Maintain follow-up until records are completed and billed.
Use EMR systems, including patient accounting and registration systems, to their full capacity.
Maintain patient confidentiality in accordance with HIPAA.
Multitask and meet deadlines; communicate with other departments, patients, families, the community, and medical staff.
Perform other duties as required and assigned.