Medical Biller - Workers Compensation Specialist

DaMar Staffing; Fresno (CA); On-site; USD 29,000 - 34,000; Full time

Benefits offered by this job

Health insurance

Training & development

Vision insurance

401(k) matching

Dental insurance

Paid time off

Savings bank

Job summary

American Family Care (AFC) is seeking an experienced Medical Biller to manage California workers' compensation billing, resolve denials, and maintain clean billing records. The role requires precision, collaboration with clinics, and adherence to state and federal regulations.

The position emphasizes managing the full billing cycle, ensuring timely reimbursements, and meeting productivity targets while working with insurance carriers and healthcare providers across the AFC network.

Qualifications

• Minimum of 2 years of medical billing experience.
• Minimum of 1 year of Workers' Compensation billing experience.
• Knowledge of CPT, ICD-10, HCPCS coding and medical terminology.
• Experience with denial management and appeals.
• Proficiency with EMR and billing software.
• Strong organizational skills and attention to detail.
• Excellent verbal and written communication skills.

Responsibilities

• Prepare and submit accurate California workers' compensation medical bills and claims.
• Verify claim information, insurance coverage, adjuster information, and billing requirements.
• Monitor claims from submission through payment.
• Follow up on unpaid, delayed, rejected, and denied claims.
• Research and resolve billing discrepancies.
• Review EOBs, payment reports, denials, and adjustments.
• Identify underpayments and take appropriate corrective action.
• Communicate professionally with insurance carriers, claims adjusters, bill review companies, attorneys, and other representatives.
• Maintain detailed documentation of all claim follow-up.
• Manage aging accounts and prioritize high-value and problem accounts.
• Assist with appeals, reconsideration, and other billing-related correspondence.
• Post payments and adjustments accurately.
• Reconcile accounts and identify outstanding balances.
• Work closely with clinical and administrative staff to resolve issues affecting reimbursement.
• Maintain accurate and organized billing records.
• Meet established productivity, accuracy, A/R, and collection goals.

Skills

Medical billing

Denial management

EMR proficiency

CPT ICD-10 HCPCS

Attention to detail

Verbal & written communication

Multi-tasking

Education

CPC/CPB certification (preferred)

Tools

EMR software

Billing software

Job description

Medical Biller

Replies within 24 hours

Benefits:

• Health insurance
• Training & development
• Vision insurance
• 401(k) matching
• Dental insurance
• Paid time off
• Savings bank

Company Overview

American Family Care (AFC) is one of the largest primary and urgent care companies in the U.S. providing services seven days a week on a walk-in basis. Our state-of-the-art centers focus on the episodic treatment of acute illnesses and injuries, workers' compensation, and occupational medicine. AFC is the parent company of AFC Franchising, LLC (AFCF). This position works directly with a franchised business location. The specific job duties and benefits can vary between franchises.

Job Summary

We are seeking an experienced and detail-oriented Medical Biller with a strong background in Workers' Compensation claims processing and billing. The ideal candidate will be responsible for managing the complete billing cycle, ensuring accurate claim submission, timely reimbursement, and compliance with applicable state and federal regulations.

Responsibilities

• Prepare and submit accurate California workers' compensation medical bills and claims.
• Verify claim information, insurance coverage, adjuster information, and billing requirements.
• Monitor claims from submission through payment.
• Follow up on unpaid, delayed, rejected, and denied claims.
• Research and resolve billing discrepancies.
• Review EOBs, payment reports, denials, and adjustments.
• Identify underpayments and take appropriate corrective action.
• Communicate professionally with insurance carriers, claims adjusters, bill review companies, attorneys, and other representatives.
• Maintain detailed documentation of all claim follow-up.
• Manage aging accounts and prioritize high-value and problem accounts.
• Assist with appeals, reconsideration, and other billing-related correspondence.
• Post payments and adjustments accurately.
• Reconcile accounts and identify outstanding balances.
• Work closely with clinical and administrative staff to resolve issues affecting reimbursement.
• Maintain accurate and organized billing records.
• Meet established productivity, accuracy, A/R, and collection goals.
• Perform other duties as assigned

Performance Expectations and Billing Goals

This position will be measured by specific monthly, quarterly, and annual performance goals. Meet monthly collection and A/R performance targets established by management. Provide a monthly A/R and collection report to management. Maintain appropriate levels of productivity while maintaining billing accuracy.

1. Claims denied or rejected
2. Denial resolution
3. Underpayment identification
4. Outstanding claims requiring follow-up
5. Collection performance compared with established goals

Qualifications

• Minimum of 2 years of medical billing experience.
• Minimum of 1 year of Workers' Compensation billing experience.
• Knowledge of medical terminology, CPT, ICD-10, and HCPCS coding.
• Experience with claim denial management and appeals.
• Proficiency with electronic medical records (EMR) and billing software.
• Strong knowledge of medical terminology, medical records management, and healthcare documentation standards.
• Strong organizational skills and attention to detail.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities and meet deadlines.

Preferred

• Experience in outpatient rehabilitation, occupational therapy, physical therapy, or healthcare clinic settings.
• Familiarity with California Workers' Compensation billing regulations and OMFS fee schedules.
• Experience working with medical providers, therapy clinics, or rehabilitation.
• Certification such as CPC, CPB, or equivalent.
• Bilingual in Spanish preferred, but not required

Compensation: $21.00 - $25.00 per hour

PS: It's All About You!

American Family Care has pioneered the concept of convenient, patient-centric healthcare. Today, with more than 250 clinics and 800 in-network physicians caring for over 6 million patients a year, AFC is the nation's leading provider of urgent care, accessible primary care, and occupational medicine. Ranked by Inc. magazine as one of the fastest-growing companies in the U.S., AFC's stated mission is to provide the best healthcare possible, in a kind and caring environment, while respecting the rights of all patients, in an economical manner, at times and locations convenient to the patient.

If you are looking for an opportunity where you can make a difference in the lives of others, join us on our mission. We invite you to grow with us and experience for yourself the satisfying and fulfilling work that the healthcare industry provides.

Please note that a position may be for a company-owned or franchise location. Each franchise-owned and operated location recruits, hires, trains, and manages their own employees, sets their own employment policies and procedures, and provides compensation and benefits determined by that franchise owner. Company-owned locations provide a comprehensive benefits package including medical, dental, vision, disability, life insurance, matching 401(k), and more.

We are an Equal Opportunity Employer.