Medical Biller ll

AmeriPharma; Laguna Hills (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

AmeriPharma in Laguna Hills, CA is seeking a Medical Biller II to manage the complete medical billing cycle for assigned accounts, ensuring timely and accurate reimbursement from government and commercial payers. This on-site role requires meticulous claim preparation and adherence to payer guidelines.

You will review patient accounts, obtain missing documentation, submit claims, verify CPT/ICD-10 coding, and resolve denials through appeals and corrections, while coordinating with Authorization,

Qualifications

• Minimum of two (2) years of experience in medical billing, accounts receivable, or revenue cycle management.
• Experience billing government and commercial insurance payers, including Medicare, Medicaid, and commercial health plans.
• Advanced knowledge of medical billing and reimbursement processes.
• Familiarity with CPT, HCPCS, ICD-10-CM codes and payer guidelines.

Responsibilities

• Review patient accounts to ensure documentation, authorizations, and insurance information are complete prior to billing.
• Prepare, review, and submit accurate medical claims to government and commercial payers in a timely manner.
• Verify coding, modifiers, place of service, units, and billing requirements per payer guidelines to maintain a clean claim rate.
• Research and resolve claim rejections, denials, underpayments, and payment variances.
• Submit corrected claims, reconsiderations, appeals, and supporting documentation as necessary.
• Collaborate with cross-functional teams to resolve billing-related issues and improve workflows.

Skills

Analytical thinking

Attention to detail

Communication skills

Organization

Problem solving

Education

High school diploma or equivalent

Tools

CPR+

Waystar

Avality

Job description

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

Job Summary

The Medical Biller II is responsible for managing the complete medical billing cycle for assigned accounts to ensure timely and accurate reimbursement from government and commercial payers.

Job Details

Location: Laguna Hills, CA (This is an on-site position; remote work is not an option at this time.)

Schedule: Monday to Friday, 8:30AM-5:00PM

Duties and Responsibilities

• Review patient accounts to ensure all required documentation, authorizations, and insurance information are complete prior to billing.
• Prepare, review, and submit accurate medical claims to government and commercial payers in a timelymanner.
• Verify coding, modifiers, place of service, units, and billing requirements in accordance with payer guidelines to maintain a clean claim rate of 98%.
• Research and resolve claim rejections, denials, underpayments, and payment variances.
• Submit corrected claims, claim reconsiderations, appeals, and supporting documentation as necessary.
• Identify trends in denials and reimbursement issues and recommend corrective actions to reduce future occurrences.
• Collaborate with the Authorization, Intake, Pharmacy, Nursing, Cash Posting, Collections, and Revenue Cycle teams to resolve billing-related issues.
• Review and correct front-end edits EDI rejections in clearinghouses- Waystar.
• Ensure compliance with payer policies, CMS regulations, HIPAA requirements, and company billing procedures.
• Review patient accounts for billing accuracy, ensuring charges are complete and supported by appropriate documentation.
• Maintain detailed account notes documenting all billing activities and payer communications.
• Review and resolve billing edits, claim rejections, and clearinghouse errors prior to claim submission.
• Research payer-specific billing requirements and implement process changes to improve claim acceptance and reimbursement.
• Assist with identifying opportunities to improve billing workflows, reduce denials, and increase collections.
• Provide guidance and support to junior billers by sharing knowledge of billing processes and payer requirements.
• Participate in departmental meetings, training sessions, audits, and quality improvement initiatives.
• Maintain established productivity, quality, and accuracy standards.
• Protect the confidentiality of patient health information in compliance with HIPAA and company policies.
• Perform other duties, special projects, and responsibilities as assigned by management.
• Foster a culture of accountability, integrity, collaboration, and service excellence.

Required Qualifications

Education

• High school diploma or equivalent required.

Experience

• Minimum of two (2) years of experience in medical billing, accounts receivable, or revenue cycle management required.
• Experience billing government and commercial insurance payers, including Medicare, Medicaid, Medicare Advantage, and commercial health plans.

Knowledge

• Advanced knowledge of medical billing and reimbursement processes.
• Strong understanding of CPT, HCPCS, ICD-10-CM diagnosis codes, modifiers, and place of service requirements.
• Knowledge of Medicare, Medicaid, commercial payer guidelines, and CMS regulations.
• Familiarity with Electronic Health Record (EHR), Electronic Medical Record (EMR), practice management, and medical billing systems.
• Understanding of Electronic Remittance Advices (ERAs), Explanation of Benefits (EOBs), clearinghouse processes, and payer portals.
• Knowledge of HIPAA regulations and patient privacy requirements.

Skills

• Strong analytical, problem-solving, and critical thinking skills.
• Excellent attention to detail with a high degree of accuracy.
• Ability to interpret payer policies and apply billing guidelines appropriately.
• Strong organizational and time management skills with the ability to prioritize multiple accounts and deadlines.
• Proficiency in Microsoft Office, including Excel, Outlook, and Word.
• Experience using medical billing software and payer portals such as CPR+, Waystar, and Avality.
• Excellent verbal and written communication skills.
• Ability to work independently while collaborating effectively with cross-functional teams.
• Ability to identify process improvement opportunities and recommend effective solutions

Preferred Qualifications

• Associate degree in Healthcare Administration, Business Administration, Health Information Management, or a related field preferred.
• Experience with specialty pharmacy, infusion therapy, or home infusion.
• Certified Professional Biller (CPB), Certified Coding Associate (CCA), Certified Professional Coder (CPC), or other relevant certification.
• Demonstrated experience managing the full medical billing lifecycle, including claim submission, denial management, appeals, and accounts receivable follow-up.
• Ability to meet departmental productivity, quality, and reimbursement goals.
• Demonstrates professionalism, accountability, reliability, and sound judgment.
• Ability to maintain strict confidentiality of patient and financial information.
• Ability to adapt to changing payer requirements, billing regulations, and departmental priorities.
• Ability to mentor and support less experienced billing staff while promoting a collaborative team environment.

AmeriPharma's Mission Statement

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 25 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.

EEO Statement

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or based on disability or any other legally protected class.