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Department:  Business Services
Status:  Full Time
Shift:  1st

The Billing Specialist processes ensures accuracy, and compliance for healthcare professional medical claims. Maintains databases, audits information and works with patients to process insurance and patient payments. The Specialist provides close communication between all parties to ensure all records are up-to date, compliant with regulations and consistent. The Specialist also answers billing inquiries, works out payment plans and employs timely follow-up collection methods to maintain revenues. The Specialist maintains confidentiality and is knowledgeable of ICD-10 codes, CPT codes, HCPCs and HIPPA. 

Essential Functions

  • Works assigned accounts receivable according to department standards
  • Keeps current knowledge of PPO, HMO, Commercial and government payer guidelines.
  • Thoroughly investigate past due invoices and minimize number of unpaid accounts for all insurance payers and self-pay balances
  • Responsible for reviewing insurance claim denials, no response, underpayments and submitting appeals to insurance companies as needed  
  • Responsible for reporting payer trends that directly impact cash flow
  • Develop collections methods that consistently lead to achieve or exceed company and department financial goals
  • Solve problems quickly and create resolutions that bring in revenue on a regular basis
  • Maintain and update accurate databases with Insurance companies and maintain credentialing paperwork with the health plans
  • Review, research underpaid claims to ensure claims are process in accordance with existing Health plan contract
  • Appropriately identify errors and re-file denied/rejected claims according to payer guidelines
  • Thoroughly review remittance codes from EOBs and take the necessary action to resolve unprocessed claims
  • Responsible for posting cash and insurance payments; and adjustments accurately per department standards.
  • Responsible for identifying and reporting denial issues and trends that may result in underpayment variances.
  • Reconcile between various systems to ensure accuracy and consistency of all data
  • Responsible for identifying credit balance and submitting refund request to accounting as needed
  • Responsible for accurately entering encounter forms into practice management systems, per department standards
  • Follow charge entry guidelines per Coding and payer guidelines
  • Close communication with all providers to ensure records are up-to-date and consistent
  • Process patient payments and resolve patient billing problems and issues
  • Work with patients to develop self-pay arrangements, and provide FAP information to patients
  • Responsible for incoming patient calls using established scripts, protocols and processes
  • Reviews high-level complaints and responds back within department standards
  • Able to multi-task in different electronic medical record and practice management systems daily
  • Responsible for updating practice management system with correct information in regards to insurance and patient registration
  • Answer billing inquiries from patients and work each call to resolution
  • Maintain regular cooperation and compliance with all regulatory, accrediting and membership-based organizations
  • Carefully prepare, review and submit patient statements
  • Research and resolve patient, providers and insurance companies concerns in a timely matter
  • Perform other duties as assigned


Education, Training and Experience: 

Billing Specialist: 2 plus years’ in the healthcare medical field of revenue cycle and medical professional billing and coding, High School diploma or higher, Computer knowledge, Knowledge of EHR systems and billing practice management systems, Excel, Office, Word, knowledge of ICD-10 codes, CPT codes, HCPCs and HIPPA



Senior Billing Specialist: 3 plus years in the healthcare medical field of revenue cycle and medical professional billing. High School diploma or higher, Computer knowledge, Knowledge of EHR systems billing practice management systems, Excel, Office, Word, knowledge of ICD-10 codes, CPT codes, HCPCs and HIPPA. Comprehensive knowledge in registration, revenue cycle practices,  self pay collections, insurance billing and payer regulations. Effective communicator, critical thinking skills, and attention detail. 

Preferred: Certified coder is preferred. 1-2 years of experience with oncology.


Skills or Other Qualifications


Ability to maintain confidentiality

Ability to: Read/Interpret documents, Write reports/correspondence, speak clearly/concisely Language: English, Listen Effectively, and Interface with the Public

Ability to: Problem Solve, use Analytical and Reasoning, be Proactive, Flexibility/Adaptive to change, Ability to Multi-task, Work under Stressful Conditions, Independent Judgment, Mathematical, Business Acumen/Demeanor, Customer Service, Teamwork/Team Player, Organization Skills


Billing Specialist is expected to participate in training and development. Has to develop the ability to problem-solve and collect.

Senior Billing Specialist: In addition to the above abilities, the Senior Billing Specialist is expected to share knowledge and participate in training and development. The Senior Billing Specialist has skill in process knowledge and computer skills, knowledge of EHR, Excel, Office, Word, Specialized knowledge of ICD-10 codes, CPT codes, HIPPA guidelines and HCPC’s

Preferred: Certified coder is preferred. Experience with billing and collections for providers in a multi-specialty setting


Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Clinic, Oncology, Medical, Law, Accounts Receivable, Healthcare, Legal, Finance

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