Medical Billing Coordinator

All Care To You•Orange, CA

12d•$18 - $22•Remote

About The Position

All Care To You is a Management Service Organization providing healthcare administrative support to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. The company describes itself as modern and growing, and promotes teamwork, support, inclusion, diverse perspectives, curiosity, initiative, and drive. It is fully remote and offers a flexible work environment and schedules. The Medical Billing Coordinator ensures timely and accurate reimbursement by managing outstanding claims and collaborating with insurance carriers, providers, and billing teams. The role involves resolving complex billing issues, maintaining compliance with industry standards, and identifying problems early so claims are processed accurately and promptly. It supports client satisfaction and the financial health of clients. Strong written and verbal communication skills are essential for working with clients and insurance representatives. The position has a quantitative production standard of 100–150 claims per week.

Requirements

At least 3 years of experience as a medical biller or in a similar role.
Excellent technical skills, including the ability to work in multiple systems simultaneously and learn new systems quickly.
Microsoft Suite experience, including Outlook, Teams, Office365, OneNote, OneDrive, and SharePoint.
Sequel Server Management Studio experience.
Confluence experience.
Azure experience.
Thorough knowledge of healthcare benefits, network participation, coordination of benefits, referral and authorization requirements, and insurance follow-up.
Working knowledge of CPT codes, ICD-10 codes, modifiers, MUE, LCD, NCD, and CCI edits.
Strong time-management skills and ability to multitask.
Ability to resolve problems using critical thinking.
Detail-oriented and highly organized.
Ability to work in a fast-paced environment while maintaining strict confidentiality.
Excellent written and verbal communication skills.

Nice To Haves

EZ-Cap experience.
Electronic Data Interchange (EDI) clearinghouse experience, specifically Office Ally.

Responsibilities

Conduct timely and accurate follow-up on professional services claims, using payer portals, secure chat, secure messaging, and telephone calls to confirm requested information has been submitted and claims are being processed.
Identify missing health plan payments and initiate tracking procedures.
Review correspondence from health plans, take appropriate action, and escalate items to designated team members when needed.
Identify pending claims and determine the next steps needed to obtain reimbursement.
Use existing queries to review limited new denials for processing errors, assign an appropriate status, correct internal errors, and resubmit claims when necessary.
Follow up with insurance carriers, providers, and other stakeholders to obtain information or documentation needed to resolve claims.
Monitor incoming provider messages and respond or escalate requests to the appropriate team member.
Identify claims with complex issues and escalate them for resolution as needed.
Research health plan reimbursement policies and procedures, clinical guidelines, coding, and CCI edits to ensure claims are billed appropriately.
Communicate with insurance companies, healthcare providers, and billing staff to resolve claims issues and answer inquiries.
Document interactions and updates in the claims management system.
Maintain accurate records of claim status, actions taken, and resolutions according to established policies and procedures.
Prepare and submit reports on claim follow-up activities and status updates to management as requested.
Ensure claims follow-up complies with company policies, industry regulations, and legal requirements.
Stay updated on insurance policy, regulatory, and industry-standard changes.
Meet the production standard of working 100–150 claims per week.
Attend departmental and company meetings as required.
Identify and report trends that may negatively affect claim payments, including processing errors, denials, or billing issues.
Investigate and resolve claims-processing and payment discrepancies or issues.
Work with other team members and departments to ensure proper claim submission.
Identify and recommend process improvements to enhance the efficiency and effectiveness of claims follow-up.
Participate in training and development opportunities to stay current with best practices and industry trends.
Perform other duties as assigned.