Medical Biller II (Bilingual Spanish or Vietnamese Required)

FAMILIES TOGETHER OF ORANGE COUNTY•Tustin, CA

29d•$25 - $28•Onsite

About The Position

Position Purpose: The Medical Billing Specialist II supports the revenue cycle team by independently performing a broad range of billing functions with moderate complexity. This role is responsible for accurate insurance verification, charge entry, claim submission, payment posting, and resolution of routine denials to ensure compliance with payer requirements and timely reimbursement. Core Duties and responsibilities, include but are not limited to: Insurance & Eligibility Verification Verify complex insurance coverage (Medi-Cal, Medicare, Managed Care, Commercial, PPO/HMO). Research and resolve discrepancies in patient coverage or eligibility. Document eligibility outcomes in the EHR/PM system. Charge Entry & Coding Support Perform charge entry and apply CPT, ICD-10, and HCPCS codes. Review encounter forms for accuracy; flag missing or incorrect documentation for provider follow-up. Apply modifiers and place-of-service codes where appropriate. Claims Processing Submit clean claims through the clearinghouse; correct rejections requiring payer-specific edits. Monitor claim acceptance and rejection reports; take corrective action promptly. Escalate high-dollar or complex denials to Specialist III or Lead. Payment Posting & Reconciliation Post payments from ERA/EOBs and reconcile with patient accounts. Apply contractual adjustments and record secondary payments. Assist in balancing daily batches and preparing reconciliation logs. Patient Accounts & Customer Service Respond to patient billing inquiries with professionalism and accuracy. Set up and monitor payment plans; explain insurance coverage and patient responsibility. Escalate disputes, sliding fee scale requests, or hardship cases to senior billing staff. Reporting & Analysis Generate A/R aging reports, claim status reports, and denial trend summaries. Identify recurring claim errors and communicate with the supervisor for process improvement. Collaboration & Compliance Communicate with providers, front desk, and registration staff regarding documentation and insurance data accuracy. Adhere to compliance guidelines for timely filing, HRSA/FQHC billing rules, and payer-specific requirements. Participate in internal audits and provide supporting documentation as needed. This job description in no way states or implies that these are the only duties to be performed by the employee. He or she will be required to follow any other instructions and to perform other duties, within scope, as assigned by his or her supervisor.

Requirements

High school diploma or equivalent required.
2+ years of medical billing experience (FQHC or primary care strongly preferred)
Working knowledge of CPT, ICD 10, and HCPCS coding.
Experience with EHR/PM systems (e.g., NextGen, eClinicalWorks, EPIC, etc.).
Attention to detail, strong organizational skills, and ability to meet deadlines.
Excellent communication and customer service skills.

Responsibilities

Verify complex insurance coverage (Medi-Cal, Medicare, Managed Care, Commercial, PPO/HMO).
Research and resolve discrepancies in patient coverage or eligibility.
Document eligibility outcomes in the EHR/PM system.
Perform charge entry and apply CPT, ICD-10, and HCPCS codes.
Review encounter forms for accuracy; flag missing or incorrect documentation for provider follow-up.
Apply modifiers and place-of-service codes where appropriate.
Submit clean claims through the clearinghouse; correct rejections requiring payer-specific edits.
Monitor claim acceptance and rejection reports; take corrective action promptly.
Escalate high-dollar or complex denials to Specialist III or Lead.
Post payments from ERA/EOBs and reconcile with patient accounts.
Apply contractual adjustments and record secondary payments.
Assist in balancing daily batches and preparing reconciliation logs.
Respond to patient billing inquiries with professionalism and accuracy.
Set up and monitor payment plans; explain insurance coverage and patient responsibility.
Escalate disputes, sliding fee scale requests, or hardship cases to senior billing staff.
Generate A/R aging reports, claim status reports, and denial trend summaries.
Identify recurring claim errors and communicate with the supervisor for process improvement.
Communicate with providers, front desk, and registration staff regarding documentation and insurance data accuracy.
Adhere to compliance guidelines for timely filing, HRSA/FQHC billing rules, and payer-specific requirements.
Participate in internal audits and provide supporting documentation as needed.