Hybrid Government Billing Specialist II (Payer Claims)

KPC Health, Inc.; Santa Ana (CA); Hybrid; USD 54,000 - 75,000; Full time

Job summary

KPC Health, Inc. in Santa Ana, CA is seeking a Government Specialist II to prepare, edit, and submit third-party payer claims for government programs. The role ensures accurate reimbursement and timely processing of payments across Medicare, Medicaid, Medi-Cal, and other payers.

Responsibilities include claims submission, account follow-up, appeals, and posting adjustments while maintaining compliance with CPT/HCPCS and HIPAA rules. Hybrid work arrangement supported.

Qualifications

• Some college preferred.
• 2 years’ experience in a medical office or hospital setting.
• Knowledge of CPT, HCPCS, HIPAA and billing regulations.

Responsibilities

• Submit primary and secondary government claims using billing editor.
• Follow up on unpaid or partially paid accounts and file appeals when needed.
• Identify accurate reimbursement amounts and post necessary adjustments.
• Identify over-payments and initiate refund requests to payers.
• Resolve coding and charging errors in appropriate systems.
• Assist with time-sensitive AR projects within deadlines.
• Document actions clearly in account notes with references.

Skills

CPT/HCPCS

HIPAA

Billing systems

Regulatory knowledge

Education

Some college

Tools

Billing editor software

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Government Specialist II (Hybrid Work Model)

Rev Cycle/CBO Full Time KPC SANTA ANA, Santa Ana, CA, US

30+ days ago Requisition ID: 1548

Salary Range: $26.00 To $36.00 Hourly

SUMMARY

For governmental third-party payers including Medicare, Medicaid, Medi-Cal, Veterans' Campus, Tri-Care, County, and other governmental payers performs third party bill paper and electronic preparation, editing, and submission to payer, ensures accurate identification of expected reimbursement amounts. Calculates and posts adjustments and write-off transactions to patient accounts receivable, collection, unpaid account follow-up, patient account analysis, preparation of appeals, identification of over-payments, initiating and processing refund request to third party payers. Escalates recurring issues preventing the effective and efficient processes needed for goal attainment.

REQUIREMENTS

RESPONSIBILITIES AND DUTIES:

• Claims submission. Responsible for ensuring timely submission of governmental claims in billing editor. On a daily basis prepares and submits primary and secondary claims using the billing editor software to submit claims electronically or hardcopy, ensuring all edits are worked in a compliant manner based on directives given by management.
• Account follow-up. Responsible for collection of unpaid or partially paid accounts by utilizing ATB reports, review of EOB’s and correspondence received from payers and taking appropriate action to resolve any issues and secure correct payment due including timely filing of appeals.
• Identification of accurate efficient reimbursement amount & posting appropriate adjustments as required.
• Identification of over-payments. Initiating and processing refund requests to third party payers in compliance with governmental regulations.
• Coding and charging errors. Ensures all charge and coding related issues are clearly identified & resolved or entered on the appropriate HIM/Charge audit spreadsheet for correction/resolution by appropriate department representation.
• Assists and successfully completes time sensitive projects as it relates to outstanding accounts receivables within the time frame stated by management.
• Maintains productivity levels within guidelines established by management. Receives an at or above team average productivity score.
• Documents clearly and succinctly in account notes all action taken on account. i.e. phone numbers, representative’s name, call reference number, corrective action taken, referrals made and specific claim submission details as appropriate.
• Performs duties with little or no errors. Remains at or above team average quality of work errors.
• Other duties as assigned.

EDUCATION & EXPERIENCE REQUIREMENTS:

• Some college preferred.
• 2 years’ experience in a medical office or hospital setting.

SKILLS & ABILITIES REQUIREMENTS:

• Knowledge of CPT, HCPC’s, HIPAA, Compliance and Regulatory issues.
• Knowledge of billing systems and software applications

PHYSICAL REQUIREMENTS:

Body Positions: Sitting and standing for prolonged periods.

Body Movements: Arm and hand dexterity.

Body Senses: Must have command of close and distant sight, color perception and hearing.

Strength: Ability to lift and move up to 25-pounds.