Patients Accounts Billing Representative II

Gateways Hospital and Mental Health Center; Los Angeles (CA); On-site; USD 60,000 - 85,000; Full time

Job summary

Gateways Hospital and Mental Health Center in Los Angeles seeks a Patient Accounts Billing Representative II to submit electronic claims (Medicare, Medi-Cal, commercial insurance) for multiple programs. The role ensures compliance with payer requirements, resolves denials, verifies insurance, maintains billing records, and supports audits and reporting.

The position requires expertise in Excel reporting, KPI tracking, and audit preparation, with collaboration across clinical and administrative

Qualifications

• Experience submitting electronic claims including Medicare, Medi-Cal, commercial insurance, and Drug Medi-Cal.
• Ability to research and resolve denials; ensure timely submission of clean claims.
• Proficiency with Excel reporting, KPI tracking, and audit preparation.

Responsibilities

• Review billing data for completeness; submit clean claims through agency systems and payer portals.
• Monitor denials and payment discrepancies; research and resubmit as needed.
• Generate weekly and monthly billing, service delivery, and financial reports.
• Collaborate with administrative staff to resolve reimbursement issues.
• Maintain compliance with regulatory requirements governing claims submission.
• Participate in audits, site reviews, and quality assurance activities.
• Review patient billing records for accurate demographics and documentation; coordinate corrections.
• Prepare report binders for month-end close.
• Protect PHI and confiden tial financial data per HIPAA and internal policies.
• Attend meetings and training sessions; perform other duties as requested.

Skills

Claims submission

Denial management

Insurance verification

Reporting & audits

HIPAA compliance

Excel proficiency

EDI / Clearinghouses

Tools

EDI / Clearinghouses

Job description

Title of Position: Patient Accounts Billing Representative II Location: Gateways Hospital - Business Office (DTLA) Exempt/Non-Exempt: Non-Exempt Union/ Non-Union: Non-Union Supervisor: Revenue Cycle Billing Manager

Gateways Hospital and Mental Health Center, located in Los Angeles, is a non‑profit organization that provides an array of comprehensive mental health services for Children, Adolescents, Transitional Aged Youth, and Adults suffering from mental illness in the Greater Los Angeles area. The organization consists of a standalone fifty‑five (55) )-bed hospital and six outlying outpatient facilities that have anywhere from fourteen (14) beds to one hundred and thirty‑four (134) beds. The organization has approximately four hundred (400) employees.

Summary Of Position

The Patient Accounts Billing Representative is responsible for accurately and timely submitting claims for all Gateways Hospital and Mental Health Center programs. The position submits electronic data interchange claims, including Medicare, Medi‑Cal, commercial insurance, and Drug Medi‑Cal claims. The representative ensures compliance with county, state, federal, and payer billing requirements; processes claims; researches and resolves denials; verifies insurance eligibility; maintains billing records; and supports audit and reporting activities. This detail‑oriented behavioral health billing professional must have experience with insurance verification, claim batching and submission, denial management, payment posting, and regulatory compliance. The representative collaborates with clinical and administrative teams to maximize reimbursement, reduce billing errors, and maintain applicable billing standards. Proficiency in Excel reporting, key performance indicator tracking, and audit preparation is also expected.

Essentials Duties

• Review billing data for completeness and accuracy; create, validate, and submit clean claims through agency-approved systems, clearinghouses, and payer portals within established filing deadlines.
• Monitor claim denials and payment discrepancies; research, correct and resubmit claims as needed.
• Generate weekly and monthly billing, service delivery and financial reports as requested or needed.
• Work with administrative staff to resolve issues impacting reimbursement.
• Maintain compliance with all regulatory agency requirements and regulations governing submission of claims.
• Participate in audits, site reviews, and quality assurance reviews as requested.
• Review patient account and billing records for required demographic, insurance, authorization, service, and supporting documentation; identify missing or inconsistent information and coordinate timely corrections before claim submission.
• Prepare report binders for accounting at the month end close
• Protect information from unauthorized access, abiding by Gateways’ Code of Confidentiality, HIPAA regulations and other regulatory agencies compliance requirements.
• Attends and participates in meetings, in-service training and other meetings as requested.
• Performs other duties as requested, and within scope of practice requirements.

Essential Skills

• Ability to prioritize competing assignments and meet claim-submission, accounts‑receivable follow‑up, audit, reporting, and month-end close deadlines.
• Proficiency in Microsoft Office applications, including Excel functions used to organize, validate, reconcile, and report billing and accounts‑receivable data.
• Ability to review high‑volume, detailed billing information accurately, identify missing or inconsistent data, and maintain complete documentation while meeting productivity standards.
• Ability to use electronic health record, practice‑management, clearinghouse, payer‑portal, and spreadsheet systems to review accounts, validate claims, submit billing, document follow‑up, and research payment activity.
• Ability to safeguard protected health information and confidential financial data, follow access and disclosure controls, and exercise sound judgment when escalating billing, privacy, or compliance concerns.