Medi-Cal Biller

We are searching for a diligent Medi-Cal Claim Follow-Up Specialist to ensure the timely and accurate collection of medical claims. The specialist will work closely with counties to rectify payment denials and receive due reimbursements. The ideal candidate will possess strong communication skills, a deep understanding of medical billing and coding, and the determination to resolve outstanding claims. Familiarity with mental health diagnosis and DSM-V Codes highly desirable.

Responsibilities

1. Review and work on unpaid claims, identifying and rectifying billing issues.

2. Communicate with counties regarding any discrepancy in payments if necessary.

3. Research and appeal denied claims.

4. Review Explanation of Benefits (EOBs) to determine denials or partial payment reasons.

5. Provide detailed notes on actions taken and next steps for unpaid claims.

6. Collaborate with the billing team to ensure accurate claim submission.

7. Maintain a comprehensive understanding of the insurance follow-up process, payer guidelines, and compliance requirements.

8. Resubmit claims with necessary corrections or supporting documentation when needed.

9. Track and document trends related to denials and work towards a resolution with the billing team.

Qualifications

1. High school diploma or equivalent required. Associate or bachelor's degree in a related field is a plus.

2. Prior experience in medical billing collections or a similar role.

3. Familiarity with medical terminology, CPT, and ICD-10 coding.

4. Proficiency in healthcare billing software.

5. Strong analytical, organizational, and multitasking skills.

6. Excellent verbal and written communication abilities.

7. Ability to navigate payer websites and use online resources to resolve outstanding claims.

8. Knowledge of HIPAA and other relevant healthcare regulations.