Medical Billing Specialist

Whole Person Care Clinic•Santa Ana, CA

About The Position

The Billing Representative is responsible for managing patient accounts, billing, and ensuring accurate and timely payment for medical services. This role involves interacting with patients, insurance companies, and healthcare providers to resolve billing discrepancies, answer inquiries, and process payments. The Billing Representative also ensures compliance with applicable healthcare regulations, maintains accurate documentation in billing systems, and supports internal teams by providing billing-related reporting and follow-up as needed.

Requirements

High School Diploma or GED equivalent required.
At least 1 years’ experience in medical billing, accounts receivable or Healthcare administration preferred.
Strong customer service skills / customer service experience required.
Proficient in using billing software, electronic health records (HER) and Microsoft Office applications.

Nice To Haves

CalAim experience desired.

Responsibilities

Generate and send patient billing statements for medical services rendered in accordance with payer and organizational guidelines.
Verify insurance coverage, eligibility, and benefits prior to and following services to ensure accurate billing and reimbursement.
Review patient accounts for accuracy, completeness, and compliance with billing and documentation requirements.
Work directly with patients to explain charges, establish payment plans, and resolve outstanding balances in a clear and compassionate manner.
Submit claims to insurance companies electronically or by mail, ensuring all required documentation and data elements are included.
Follow up on outstanding claims, underpayments, and denials to ensure timely resolution and reimbursement.
Research, correct, and resubmit denied or rejected claims, including initiating appeals when appropriate.
Collaborate with insurance carriers, clearinghouses, and internal teams to resolve billing discrepancies and payment delays.
Receive, process, and post payments from patients and insurance companies accurately and in a timely manner.
Reconcile patient accounts and resolve payment posting discrepancies as needed.
Prepare and maintain financial and billing reports, including accounts receivable, billing trends, and payment collections.
Address patient inquiries regarding billing statements, insurance coverage, payment options, and financial responsibility.
Provide ongoing assistance and guidance to patients navigating the billing and insurance process.
Resolve patient concerns and complaints professionally, courteously, and in accordance with organizational policies.
Maintain accurate, detailed, and up-to-date records of patient accounts, billing activities, and communications.
Ensure compliance with all applicable healthcare regulations, payer requirements, and billing guidelines, including HIPAA.
Maintain current knowledge of payer rules, reimbursement methodologies, and billing best practices.
Coordinate with clinical, administrative, and authorization teams to resolve documentation or coding issues impacting billing.
Assist with internal audits, billing reviews, and compliance activities as requested.
Identify billing trends, process gaps, or recurring issues and communicate findings to leadership.
Support continuous improvement efforts aimed at increasing billing accuracy, efficiency, and patient satisfaction.
Perform other billing- and revenue-cycle–related duties as assigned