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About The Position
The Billing Specialist supports accurate and timely revenue cycle operations for outpatient services, ensuring compliant charge capture, claim submission, and reimbursement. This role partners closely with clinical, administrative, and payer stakeholders to resolve billing issues, reduce denials, and improve overall financial performance—while supporting equitable access to care through efficient, patient-centered billing practices.
Requirements
- High school diploma or equivalent required
- 2–4+ years of outpatient medical billing experience (clinic, FQHC, or hospital outpatient preferred).
- Experience with Medi-Cal/Medicaid, Medicare, and commercial payer billing.
- Working knowledge of CPT, ICD-10, and HCPCS coding as it relates to billing.
- Familiarity with EHR/PM systems (e.g., Athena, Epic, NextGen, eClinicalWorks, or similar).
Nice To Haves
- Associate’s or Bachelor’s degree preferred.
- Certification (e.g., CPC, CPB through AAPC or equivalent).
- Experience in multi-site or high-volume outpatient environments.
- Background in behavioral health, public health, or community-based care settings.
Responsibilities
- Prepare, review, and submit outpatient claims (professional and/or facility) to commercial, Medicaid/Medi-Cal, and Medicare payers.
- Ensure accurate coding alignment (CPT, HCPCS, ICD-10) and charge entry based on clinical documentation.
- Monitor claim status and follow up on unpaid or denied claims in a timely manner.
- Investigate and resolve claim denials, rejections, and underpayments.
- Work assigned accounts receivable (A/R) queues to meet productivity and aging targets.
- Identify root causes of denials and escalate trends to leadership with recommendations.
- Maintain compliance with payer guidelines, regulatory requirements, and organizational policies.
- Support internal and external audits by ensuring documentation and billing accuracy.
- Stay current on billing rules, payer updates, and coding changes.
- Partner with front desk, clinical teams, and coding staff to resolve charge discrepancies.
- Communicate with payers and patients to clarify billing issues or missing information.
- Contribute to workflow improvements that enhance billing efficiency and patient experience.
- Track key billing metrics (clean claim rate, denial rate, days in A/R).
- Recommend process improvements to reduce errors and accelerate reimbursement.
- Support implementation of new billing tools, workflows, or payer requirements.
Benefits
- Opportunity to collaborate with cross-functional leaders across Behavioral Health, Medical, Street Medicine, Public Health, Rural Health, and Tribal Health initiatives.
