Workers' Comp Medical Billing Specialist

American Family Care; 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

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.