Sr. Billing & Claims Specialist

OneOncology; Orange (CA); Presencial; USD 32.000 - 51.000; Jornada completa

Descripción de la vacante

The Los Angeles Cancer Network in Orange, California is seeking a Senior Billing & Claims Specialist to lead medical billing and claims processing for a physician practice. You’ll verify insurance, monitor denial trends, and ensure timely reimbursement in a fast-paced healthcare environment.

Candidate should have 3–5 years of medical billing experience, CPT/ICD-10-CM coding knowledge, and proficiency with EHR and billing software.

Formación

• 3–5 years of medical billing and claims experience, preferably in a physician practice or specialty healthcare setting.
• Strong knowledge of CPT, ICD-10-CM, HCPCS coding and billing requirements.
• Experience with commercial insurance, Medicare, and Medi-Cal claims.
• Proficiency with EHR, practice management systems, and billing software.

Responsabilidades

• Review, prepare, and submit medical claims to insurance companies and other third-party payers.
• Verify patient insurance eligibility, benefits, and authorization requirements as needed.
• Monitor claim status and follow up on unpaid, denied, and rejected claims to support timely reimbursement.
• Investigate and resolve claim denials, billing discrepancies, and payment variances.
• Review EOBs and ERAs to ensure accurate payment posting and reimbursement.
• Identify trends in claim denials and recommend process improvements to reduce billing errors and improve collections.
• Research payer policies, reimbursement guidelines, and billing requirements.
• Communicate with insurance representatives, patients, and internal departments to resolve billing and claims issues.
• Maintain accurate billing documentation and ensure compliance with applicable healthcare regulations, payer requirements, and organizational policies.
• Assist with accounts receivable follow-up, aging reports, and revenue cycle reporting.
• Support and mentor billing team members by sharing best practices and providing guidance on complex claims.

Conocimientos

Medical billing

Insurance claims

Analytical thinking

Communication

Independence

Educación

High school diploma

Billing/healthcare administration training

Herramientas

EHR software

Billing software

Practice management systems

Descripción del empleo

The mission of The Los Angeles Cancer Network is to provide unparalleled care to each patient that comes through our doors. We offer individualized treatment using the most recent and relevant proven advances in cancer care, curated with deliberation and compassion. LACN is committed to educating and supporting our patients and their families through every step of the way. We deliver a unique approach for every patient to ensure they receive treatment best suited to their condition, age, and other important factors. We do this by participating in important clinical research, encouraging screenings for early detection, and providing innovative treatment. We are proud to be at the forefront of cancer research through our partnership with OneOncology.

Why Join Us?

We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve.

Job Description

Location: Orange, California

Employment Type: Full-Time

We are seeking an experienced Senior Billing & Claims Specialist to join our physician practice in California. This role is responsible for managing medical billing and claims processes, ensuring accurate and timely claim submission, resolving billing discrepancies, and supporting the revenue cycle. The ideal candidate has strong knowledge of medical billing, insurance claims, and reimbursement processes, preferably within a physician practice or healthcare setting.

Key Responsibilities

• Review, prepare, and submit medical claims to insurance companies and other third-party payers.
• Verify patient insurance eligibility, benefits, and authorization requirements as needed.
• Monitor claim status and follow up on unpaid, denied, and rejected claims to support timely reimbursement.
• Investigate and resolve claim denials, billing discrepancies, and payment variances.
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) to ensure accurate payment posting and reimbursement.
• Identify trends in claim denials and recommend process improvements to reduce billing errors and improve collections.
• Research payer policies, reimbursement guidelines, and billing requirements.
• Communicate with insurance representatives, patients, and internal departments to resolve billing and claims issues.
• Maintain accurate billing documentation and ensure compliance with applicable healthcare regulations, payer requirements, and organizational policies.
• Assist with accounts receivable follow-up, aging reports, and revenue cycle reporting.
• Support and mentor billing team members by sharing best practices and providing guidance on complex claims.
• Perform additional duties as assigned.

Qualifications

• High school diploma or equivalent required; additional education in medical billing, healthcare administration, or a related field is preferred.
• Minimum of 3–5 years of medical billing and claims experience, preferably in a physician practice or specialty healthcare setting.
• Strong understanding of medical terminology, insurance billing, reimbursement processes, and claims resolution.
• Experience working with commercial insurance, Medicare, and Medi-Cal claims preferred.
• Knowledge of CPT, ICD-10-CM, and HCPCS coding and billing requirements.
• Experience researching and resolving claim denials, rejections, and outstanding accounts receivable.
• Proficiency with electronic health records (EHR), practice management systems, and billing software.
• Strong analytical, organizational, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to manage competing priorities, meet deadlines, and work independently in a fast-paced environment.
• Strong attention to detail and commitment to accuracy, confidentiality, and compliance.

Compensation

The anticipated pay range for this position is $23.00–$37.00 per hour, depending on qualifications, relevant experience, skills, and other permissible factors.