Medical Biller/Collector

PreludeDx; Laguna Hills (CA); On-site; USD 52,000 - 70,000; Full time

Job summary

A health technology company in Laguna Hills is seeking an entry-level professional to handle collections and medical billing for various regional and national payers. The ideal candidate will have strong knowledge of medical billing, excellent problem-solving skills, and proficiency in Microsoft Office applications. This full-time position requires attention to detail and the ability to work independently while meeting departmental cash goals.

Qualifications

• Minimum four years of related experience required.
• Hands-on experience with medical billing and reimbursement needed.
• Ability to manage time and work independently.
• Strong problem-solving skills, attention to detail and ability to follow through.
• Excellent customer service and written and verbal communication skills.

Responsibilities

• Perform collections and medical billing for various payers.
• Data entry and verify insurance eligibility.
• Process appeals and report denial reasons.
• Investigate denials, file appeals when appropriate, and report root causes.
• Process appeals, track outcomes and evaluate results.
• Maximize use of billing system and tools to support collections.
• Review aging, adjustments and credit balance reports.
• Comply with HIPAA and other safety and regulatory standards.
• Support department cash and DSO goals; perform other duties as assigned.

Skills

Medical billing knowledge

Problem-solving skills

Customer service skills

Attention to detail

Communication skills

Communication skills

Problem-solving

Independence

Teamwork

Education

High School Diploma or Bachelor's degree

Bachelor's degree

Tools

Microsoft Outlook

Microsoft Excel

Microsoft Word

Job description

Job Summary

This position will perform collections and medical billing for various regional and national payers, including Federal, State, Third Party (HMO, PPO, IPA, TPA Indemnity) and patient billing. Qualified candidates must review accounts for billing accuracy to maximize reimbursement, pursue tenacious follow‑up on claim status, appeal, re‑bill or forward claims for recalculation, and possess detailed knowledge of all medical benefit levels and federal, state, PPO, HMO and indemnity plan structures. Candidates must meet or exceed performance standards on assigned accounts.

Essential Responsibilities

• Data entry and correct insurance assignment to patient accounts, verify insurance eligibility, and review/update demographics and patient information for accuracy.
• Apply appropriate coding systems (CPT, ICD‑9, HCPCS, coverage, LCD/NCD) and understand reimbursement associated with such codes.
• Process, validate payer requests and processed claims via correspondence, remittance advice and EOBs, identifying payment discrepancies and inappropriate requests.
• Investigate denied services to determine denial reasons, file appeals when appropriate, and report root causes of denials.
• Process appeals timely, develop, submit, track, report and evaluate appeal outcomes.
• Maximize use of billing system, tools and resources to support cash‑collection activities.
• Review aging, adjustments and credit balance reports.
• Comply with federal and state legislation, safety, emergency, OSHA, HIPAA, quality assurance and administrative plans, policies, guidelines, protocols and standards.
• Support and maintain department cash and DSO goals.
• Other duties as assigned.

Requirements

• High School Diploma and a minimum of four years related experience, or Bachelor’s degree (or combination of education and experience).
• Working knowledge and hands‑on experience of medical billing and reimbursement.
• Proficiency with Microsoft Outlook, Excel, Word and related business applications.
• Strong problem‑solving skills, good judgment, attention to detail and follow‑through.
• Excellent customer service, verbal and written communication skills.
• Ability to prioritize, multi‑task, manage time and work independently.
• Adaptability to increased business demands and complex billing issues.
• Team‑work orientation and supportive collaboration with colleagues.

Seniority Level

Entry level

Employment Type

Full‑time

Job Function

Health Care Provider