Out-of-Network Medical Billing and Appeals Specialist - Plastic Surgery

Pacific Plastic Surgery Group•San Francisco, CA

25d•$80,000 - $90,000•Onsite

About The Position

An established plastic surgery practice in San Francisco is seeking an experienced Medical Billing Specialist to support its growing billing team. This hands-on, in-office role on a small, close-knit team works directly with the front desk, clinical staff, and leadership. The specialist owns key parts of the revenue cycle, from claim submission through resolution, and helps ensure the practice is paid accurately for the care it provides. The position manages claims for surgical and in-office procedures, including out-of-network billing, denials, underpayments, and appeals. It also supports patient billing questions and cost estimates and participates in revenue recovery, including No Surprises Act IDR arbitration. Applicants are asked to submit a resume or CV and a cover letter describing their relevant experience and interest in the role. The employer is an equal opportunity employer and will consider qualified applicants with arrest and conviction records in accordance with applicable fair chance laws.

Requirements

At least 3 years of medical billing experience; surgical specialties or private practice experience preferred.
Experience managing claims end to end, including denials, underpayments, and appeals.
Strong working knowledge of CPT, ICD-10, and HCPCS coding for surgical procedures.
Experience with insurance plans, eligibility verification, and benefits interpretation.
Experience with out-of-network billing, or ability to learn out-of-network workflows and reimbursement strategies quickly.
Experience with EMR/EHR and billing or practice management systems.
Proficiency in Microsoft Office, especially Excel.
Ability to work on-site full-time with strong attendance and reliability.
Detail-oriented and accurate, including during high-volume periods.
Organized, able to manage multiple claims and deadlines, and persistent in problem-solving.
Clear, professional communication with payers, patients, and coworkers.
Independent and proactive, while working collaboratively and welcoming feedback.

Nice To Haves

Experience in plastic surgery, cosmetic procedures, or cash-pay settings.
Experience with patient billing or cost estimates.
CPC or similar certification.

Responsibilities

Manage the full claims lifecycle, including submission, follow-up, and resolution, for surgical and in-office procedures.
Verify eligibility and interpret benefits for commercial PPO plans, including out-of-network coverage.
Work denied and underpaid claims, identify root causes, and prepare insurance appeals.
Communicate with payers by phone and through payer portals to resolve claims.
Track claims, accounts receivable, and follow-up activity in Excel and the practice management system.
Partner with the front desk and clinical team to capture accurate information and prevent denials.
Support patient billing questions and cost estimates as needed.
Participate in the full revenue lifecycle and revenue recovery, including No Surprises Act IDR arbitration.