Healthcare Claims Medical Billing Specialist

Join Our Team as a Medical Billing Specialist! As a Medical Biller, you will play a crucial role in managing the initial and secondary billing processes, as well as conducting follow-ups for government and non-government claims. Collaborating with various departments, you will contribute to achieving both departmental and organizational goals. Your problem-solving skills will be essential in addressing billing issues and communicating trends regarding compliance and payment processes. Familiarity with payer requirements and governmental regulations is vital for success in this position. This is a hybrid role that requires working in our San Marcos, CA or El Segundo, CA offices two days a week and three days from home. Key Responsibilities: Focus on hospital billing. Manage the correction and submission of electronic and hardcopy claims. Submit adjusted claims and provide thorough follow-up on billing items. Prepare billing reconciliation for accuracy. Your Daily Tasks Will Include: Downloading and reconciling claims daily from the patient accounting system to the electronic billing system. Transmitting or releasing claims on a daily basis. Resolving billing edits, validating claims, or holding them for departmental review. Following up on any held or unreleased claims promptly. Submitting claims through the electronic billing system. Reviewing admission reports to determine if accounts should be merged. Updating insurance master records with any address or plan changes. Filing adjusted billings based on audits or diagnosis changes. Keeping patient accounts up to date with accurate demographic and insurance information. Addressing rejection and payer audit reports within 48 hours and taking necessary actions for resolution. Monitoring denial trends and reporting findings to your supervisor. Re-billing as necessary to ensure account resolution. Ensuring compliance with state and federal regulations, including HIPAA. Completing assigned special projects effectively within set time frames. Documenting relevant information in electronic billing and patient accounting systems. Participating in training sessions and seminars hosted by the Hospital and Third Party Payers. Providing professional customer service through handling all calls and communications promptly. Adhering to the facility’s mission and values in all interactions. Qualifications: High School Diploma or GED, or 3 years of relevant experience in lieu of diploma. 0-2 years experience in healthcare, insurance, finance, or customer service sectors. Understanding of insurance claims, billing processes, coding, finance, or related responsibilities. Preferred Qualifications: Previous experience in billing. Background in hospital billing. Strong communication and interpersonal skills. Proficiency with Excel and Word software. What We Offer: A competitive compensation and flexible benefits package. Benefits include medical, dental, vision insurance, and more. Paid time off for personal and family needs, along with company holidays. 401(k) Retirement Plan. Tuition reimbursement and personal development opportunities. Employee Referral Program and corporate-sponsored events. Emergency Back-Up Childcare Program. About Us: Guidehouse is committed to diversity and equal opportunity employment. We welcome applicants from all backgrounds and strive to create an inclusive workplace.