Medical Billing Specialist

Harmony Health Medical Clinic & Family Resource Center; Marysville (CA); On-site; USD 28,000 - 39,000; Full time

Job summary

Harmony Health Medical Clinic & Family Resource Center in Marysville, CA seeks a skilled medical billing specialist to manage claims submission, posting, denials, and patient inquiries in a fast-paced clinic environment. You will verify demographics and insurance data, submit CMS-1500 and UB-04 claims, review EHR notes, and follow up on accounts receivable while upholding HIPAA and payer requirements.

Attention to detail, ability to work with clinical and administrative teams, and bilingual

Qualifications

• High school diploma or equivalent.
• One to two years of medical billing experience preferred.
• Experience in a healthcare clinic or FQHC is a plus.
• Knowledge of medical billing procedures, insurance claims submission, payment posting, denials management, and accounts receivable follow-up.
• Familiarity with Medicare, Medi-Cal, and other government programs.
• HIPAA privacy knowledge.
• Proficiency with EHR and Microsoft Office.
• Bilingual preferred.

Responsibilities

• Review and verify patient demographics, insurance coverage, billing information, and supporting documentation for accurate claims submission.
• Prepare, submit, and track electronic and paper insurance claims, including CMS-1500 and UB-04 forms.
• Post insurance payments, patient payments, charges, contractual adjustments, and denials accurately.
• Investigate and resolve rejected, denied, and underpaid claims; submit corrected claims and appeals as appropriate.
• Monitor accounts receivable, maintain accurate billing records, and follow up on outstanding claims and unpaid balances.
• Communicate with insurance payers, patients, and internal departments to resolve billing questions and discrepancies.
• Stay informed of changes to billing guidelines, insurance policies, coding requirements, and reimbursement procedures.
• Identify opportunities to improve billing workflows, reduce claim denials, and support efficient revenue cycle operations.

Skills

Medical billing

HIPAA compliance

ICD-10 coding

CPT/HCPCS coding

Insurance claims processing

Payment posting

Denials management

Electronic health records

Microsoft Office

Bilingual (preferred)

Education

High school diploma or equivalent

Medical billing certification (CPB) preferred

Tools

Epic

Billing software

Practice management system

CMS submission knowledge

Job description

Qualifications:

High school diploma or equivalent One to two years of medical billing experience preferred; experience in a healthcare clinic or federally qualified health center (FQHC) is a plus Knowledge of medical billing procedures, insurance claims submission, payment posting, denials management, and accounts receivable follow-up Familiarity with commercial insurance, Medicare, Medi-Cal, and other government healthcare programs - Knowledge of managed care contracts, legal requirements, and fee schedules may be required - Knowledge of PPOs, Medicare, Medi-Cal, and state programs such as CPSP, FPACT, and EWC - Must possess knowledge of ICD-10, CPT, HCPCS - Medical terminology and an understanding of HIPAA privacy law - Proficiency with electronic health records, practice management systems, and Microsoft Office applications - Ability to manage competing priorities, meet deadlines, and work collaboratively with clinical and administrative teams. - Medical billing certification (such as Certified Professional Biller CPB) preferred but not required - Working knowledge of Epic preferred - Bilingual preferred

Essential Responsibilities:

- Review and verify patient demographics, insurance coverage, billing information, and supporting documentation for accurate claims submission - Prepare, submit, and track electronic and paper insurance claims, including CMS-1500 and UBs-04 forms - Review medical records and billing codes for accuracy, completeness, and compliance with payer requirements - Post insurance payments, patient payments, charges, contractual adjustments, and denials accurately - Review remittance advice and explanations of benefits to identify payment discrepancies and determine appropriate follow-up - Investigate and resolve rejected, denied, and underpaid claims; submit corrected claims and appeals as appropriate - Monitor accounts receivable, maintain accurate billing records, and follow up on outstanding claims and unpaid balances - Review and complete assigned billing work queues daily to support timely claims processing and resolution - Communicate with insurance payers, patients, and internal departments to resolve billing questions and discrepancies - Assist patients with billing inquiries and establish payment plans in accordance with organizational policies - Prepare and review accounts receivable reports and identify trends affecting reimbursement - Maintain patient confidentiality and comply with HIPAA, payer requirements, and applicable billing regulations - Stay informed of changes to billing guidelines, insurance policies, coding requirements, and reimbursement procedures - Identify opportunities to improve billing workflows, reduce claim denials, and support efficient revenue cycle operations. - Perform other related duties as assigned.

Current Basic Life Support (BLS) certification