Sr. Billing & Claims Specialist

OneOncology•Orange, CA

1d•$23 - $37

About The Position

The Los Angeles Cancer Network is seeking an experienced Senior Billing & Claims Specialist to join its physician practice in Orange, California. The role manages medical billing and claims processes, ensuring accurate and timely claim submission, resolving billing discrepancies, and supporting the revenue cycle. The ideal candidate has strong knowledge of medical billing, insurance claims, and reimbursement processes, preferably in a physician practice or healthcare setting. The specialist works with insurance companies, third-party payers, patients, and internal departments to resolve billing and claims issues. The role also supports accounts receivable follow-up and revenue cycle reporting, maintains compliant billing documentation, and shares expertise with billing team members.

Requirements

High school diploma or equivalent required.
Minimum of 3–5 years of medical billing and claims experience, preferably in a physician practice or specialty healthcare setting.
Strong understanding of medical terminology, insurance billing, reimbursement processes, and claims resolution.
Knowledge of CPT, ICD-10-CM, and HCPCS coding and billing requirements.
Experience researching and resolving claim denials, rejections, and outstanding accounts receivable.
Proficiency with electronic health records (EHR), practice management systems, and billing software.
Strong analytical, organizational, and problem-solving skills.
Excellent written and verbal communication skills.
Ability to manage competing priorities, meet deadlines, and work independently in a fast-paced environment.
Strong attention to detail and commitment to accuracy, confidentiality, and compliance.

Nice To Haves

Additional education in medical billing, healthcare administration, or a related field.
Experience in a physician practice or specialty healthcare setting.
Experience working with commercial insurance, Medicare, and Medi-Cal claims.

Responsibilities

Review, prepare, and submit medical claims to insurance companies and other third-party payers.
Verify patient insurance eligibility, benefits, and authorization requirements as needed.
Monitor claim status and follow up on unpaid, denied, and rejected claims to support timely reimbursement.
Investigate and resolve claim denials, billing discrepancies, and payment variances.
Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) to ensure accurate payment posting and reimbursement.
Identify trends in claim denials and recommend process improvements to reduce billing errors and improve collections.
Research payer policies, reimbursement guidelines, and billing requirements.
Communicate with insurance representatives, patients, and internal departments to resolve billing and claims issues.
Maintain accurate billing documentation and ensure compliance with applicable healthcare regulations, payer requirements, and organizational policies.
Assist with accounts receivable follow-up, aging reports, and revenue cycle reporting.
Support and mentor billing team members by sharing best practices and providing guidance on complex claims.
Perform additional duties as assigned.