Medi-Cal Billing Specialist

Pyramid Consulting, Inc; Pomona (CA); On-site; USD 29,000 - 33,000; Part time

Benefits offered by this job

Health insurance

401(k)

Paid sick leave

Job summary

Pyramid Consulting, Inc. is seeking a Medi-Cal Billing Specialist for a 3+ months contract in Pomona, CA (onsite).

The role focuses on hospital accounts receivable, pursuing insurance collections, and ensuring accurate UB-04 processing. You will verify eligibility, follow up with payers, resolve denials, and document activities in the hospital billing system, while complying with HIPAA and state/federal requirements.

Qualifications

• 1–3 years of experience in hospital accounts receivable, medical billing, or healthcare collections.
• Experience following up on institutional claims (UB-04).
• Understanding of CPT/ICD codes and DRG reimbursement.
• Familiarity with Medi-Cal, Medicare, and commercial payers.
• Strong communication and analytical skills.
• High School Diploma or GED.

Responsibilities

• Review hospital accounts receivable aging reports and prioritize collection efforts.
• Follow up with insurance carriers to collect outstanding balances and resolve claim issues.
• Perform timely follow-up on institutional claims (UB-04).
• Investigate denied, rejected, or underpaid claims and submit appeals when appropriate to maximize reimbursement.
• Identify and resolve payment variances and account discrepancies.
• Obtain and verify patient insurance eligibility through insurance websites, payer portals, and customer service representatives.
• Coordinate with billing and other internal departments to resolve claim and account discrepancies.
• Document all collection and follow-up activities accurately in the hospital's billing system.
• Maintain accurate account records and follow established billing and collection procedures.
• Ensure compliance with HIPAA, hospital policies, and applicable state and federal regulations.
• Communicate professionally and effectively with insurance carriers, internal departments, and other stakeholders.

Skills

Hospital AR

Medical billing

Healthcare collections

CPT/ICD/DRG

Payer portals

HIPAA compliance

Communication skills

Hospital billing systems

Microsoft Office

Education

High School Diploma or GED

Tools

Microsoft Office

Hospital billing systems

Job description

Job ID: 26-26626

Immediate need for a talented Medi-Cal Billing Specialist. This is a 03+ months contract opportunity with long-term potential and is located in Pomona, CA(Onsite).

Pay Range: $21 - $24/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Review hospital accounts receivable aging reports and prioritize collection efforts
• Follow up with insurance carriers to collect outstanding balances and resolve claim issues
• Perform timely follow-up on institutional claims (UB-04)
• Investigate denied, rejected, or underpaid claims and submit appeals when appropriate to maximize reimbursement
• Identify and resolve payment variances and account discrepancies
• Obtain and verify patient insurance eligibility through insurance websites, payer portals, and customer service representatives
• Coordinate with billing and other internal departments to resolve claim and account discrepancies
• Document all collection and follow-up activities accurately in the hospital's billing system
• Maintain accurate account records and follow established billing and collection procedures
• Ensure compliance with HIPAA, hospital policies, and applicable state and federal regulations
• Communicate professionally and effectively with insurance carriers, internal departments, and other stakeholders

Key Requirements and Technology Experience:

• Must have skills: 1-3 years of experience in hospital accounts receivable, medical billing, or healthcare collections
• Experience following up on institutional claims (UB-04)
• Understanding of CPT/ICD codes and DRG reimbursement
• 1-3 years of experience in hospital accounts receivable, medical billing, or healthcare collections
• Experience following up on institutional claims (UB-04)
• Experience working with insurance companies and payer portals
• Knowledge of hospital billing and accounts receivable processes
• Understanding of CPT/ICD codes and DRG reimbursement
• Familiarity with payer guidelines, including Medi-Cal, Medicare, and commercial payers
• Strong communication skills for interacting with insurance carriers and payer representatives
• Proficiency with hospital billing systems and Microsoft Office
• Strong attention to detail and analytical skills
• Ability to investigate claim denials, underpayments, and payment variances
• Knowledge of insurance eligibility verification through payer websites, portals, and customer service
• High School Diploma or GED

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.