Medical Biller
26 days ago
San Diego
Job Description Benefits/Perks • Competitive Compensation, • Great Work Environment, • Process medical billing and follow up on claims with Medi-Cal and managed care payors, • Audit and evaluate clinical documentation and billing records to ensure they are accurate, timely, clinically appropriate, justify medical necessity for Medi-Cal reimbursement, and comply with all State and County documentation and billing requirements., • Run reports from the designated electronic health record (EHR) to assist program in complying with County and state documentation and billing requirements, perform data validation, and conduct quality control checks., • Provide oversight and track all billing and coding corrections to ensure accurate and timely billing for designated program/ program staff., • Interpret and apply complex insurance contract terms to determine appropriate reimbursement, • Work closely with clinical staff, programs and billing department to resolve billing issues and ensure smooth operations., • Serve as a Medi-Cal billing expert for CRF program staff. Provide consultation and feedback to program management and direct care staff regarding accurate billing and documentation practices., • Verify patient insurance eligibility and benefits for Medicare and Medi-Cal., • Provide updates to management on claim billing status, trends and outstanding errors., • Maintain a high level of confidentiality., • Review, correct, and submit complex claims with a focus on accuracy, timeliness, and payer-specific requirements., • Track and analyze denial rates, initiating corrective actions to reduce rejections and improve reimbursement., • Accurately code and post Medicare Remittance Advice, ensuring complete and compliant documentation., • Analyze reimbursement trends, payer behavior, and billing performance to identify opportunities for revenue enhancement., • Deliver actionable insights and strategic recommendations to senior leadership through data-driven reporting., • Partner with finance and compliance teams to ensure billing data aligns with broader organizational metrics and goals., • Ensure full adherence to HIPAA, CMS, Medi-Cal, and other payer-specific regulations., • Serve as a subject matter expert on billing regulations, payer requirements, and industry best practices.Qualifications, • Experience in Behavioral Health medical billing, particularly with Medi-Cal and managed care, • Strong analytical and problem-solving skills, • Previous experience with medical coding, • Highly detail-oriented and organized, • Knowledge of healthcare billing, payer requirements, and insurance claim processing, • Familiarity with healthcare IT systems, including interfaces and integrations., • Strong communication and interpersonal skills. Experience: 3-5 years of experience in a mental health setting, including one year of experience generating reports, data analysis, auditing, and compliance. Education Required: • High School diploma or equivalent required