Medical Billing Specialist

• Verify patient eligibility for Medi-Cal and confirm Managed Care Plan assignments for services rendered
• Prepare and submit claims accurately using appropriate coding and modifiers, including electronic equivalents of CMS-1500 forms
• Post payments, reconcile accounts, and ensure adjustments and write-offs align with contractual requirements
• Analyze denied or underpaid claims, identify issues, and resubmit them to secure proper reimbursement
• Manage appeals by reviewing Explanation of Benefits and engaging with the appeals process to resolve claim discrepancies
• Maintain secure and compliant records of Protected Health Information used in billing activities
• Assist healthcare providers with billing inquiries and support case management practices to enhance revenue
• Ensure all billing activities align with Medi-Cal Provider Manual and Managed Care Plan guidelines
• Collaborate with internal teams to streamline billing processes and improve efficiency

• Minimum of three years of experience in medical billing
• At least one year focused on Medi-Cal programs
• Proven ability to handle claims denials and appeals processes effectively
• Strong knowledge of medical billing codes, including Z1032, Z1034, and Z1036, and appropriate modifiers such as XP and 95
• Familiarity with telehealth billing practices and compliance requirements
• Experience in medical billing and specialized areas such as OBGYN
• Proficiency in payment posting, data reconciliation, and financial adjustments
• Understanding of Protected Health Information (PHI) security and compliance standards
• Excellent organizational and communication skills to collaborate with healthcare providers and internal teams

Experience in OBGYN and/or Perinatal Services

• medical
• vision
• dental
• life and disability insurance
• eligible to enroll in company 401(k) plan