Apex Recovery Rehab
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Job Summary We are currently seeking a detail-oriented and dedicated
Medical Biller
to join our team. In this role, you will be responsible for managing the billing and collection of outstanding account balances for
Medi-Cal
and managed care payors. You will analyze and interpret complex payor contract language to calculate expected reimbursements accurately and ensure timely collection of all payments owed to the organization.
Benefits
401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance
Competitive Compensation
Great Work Environment
Career Advancement Opportunities
Responsibilities
Process medical billing and follow up on claims with Medi-Cal and managed care payors
Audit and evaluate clinical documentation and billing records to ensure they are accurate, timely, clinically appropriate, justify medical necessity for Medi-Cal reimbursement, and comply with all State and County documentation and billing requirements.
Run reports from the designated electronic health record (EHR) to assist program in complying with County and state documentation and billing requirements, perform data validation, and conduct quality control checks.
Provide oversight and track all billing and coding corrections to ensure accurate and timely billing for designated program/ program staff.
Interpret and apply complex insurance contract terms to determine appropriate reimbursement
Work closely with clinical staff, programs and billing department to resolve billing issues and ensure smooth operations.
Serve as a Medi-Cal billing expert for CRF program staff. Provide consultation and feedback to program management and direct care staff regarding accurate billing and documentation practices.
Verify patient insurance eligibility and benefits for Medicare and Medi-Cal.
Provide updates to management on claim billing status, trends and outstanding errors.
Maintain a high level of confidentiality.
Review, correct, and submit complex claims with a focus on accuracy, timeliness, and payer-specific requirements.
Track and analyze denial rates, initiating corrective actions to reduce rejections and improve reimbursement.
Accurately code and post Medicare Remittance Advice, ensuring complete and compliant documentation.
Analyze reimbursement trends, payer behavior, and billing performance to identify opportunities for revenue enhancement.
Deliver actionable insights and strategic recommendations to senior leadership through data-driven reporting.
Partner with finance and compliance teams to ensure billing data aligns with broader organizational metrics and goals.
Ensure full adherence to HIPAA, CMS, Medi-Cal, and other payer-specific regulations.
Serve as a subject matter expert on billing regulations, payer requirements, and industry best practices.
Qualifications
Experience in Behavioral Health medical billing, particularly with Medi-Cal and managed care
Strong analytical and problem-solving skills
Previous experience with medical coding
Highly detail-oriented and organized
Knowledge of healthcare billing, payer requirements, and insurance claim processing
Familiarity with healthcare IT systems, including interfaces and integrations.
Strong communication and interpersonal skills.
Experience: 3-5 years of experience in a mental health setting, including one year of experience generating reports, data analysis, auditing, and compliance.
Education Required: High School diploma or equivalent required
Seniority level: Mid-Senior level | Employment type: Full-time | Job function: Health Care Provider | Industries: Mental Health Care
Referrals increase your chances of interviewing at Apex Recovery Rehab by 2x
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San Diego, CA .
Spring Valley, CA $23.00-$25.00 6 days ago
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Get AI-powered advice on this job and more exclusive features.
Job Summary We are currently seeking a detail-oriented and dedicated
Medical Biller
to join our team. In this role, you will be responsible for managing the billing and collection of outstanding account balances for
Medi-Cal
and managed care payors. You will analyze and interpret complex payor contract language to calculate expected reimbursements accurately and ensure timely collection of all payments owed to the organization.
Benefits
401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance
Competitive Compensation
Great Work Environment
Career Advancement Opportunities
Responsibilities
Process medical billing and follow up on claims with Medi-Cal and managed care payors
Audit and evaluate clinical documentation and billing records to ensure they are accurate, timely, clinically appropriate, justify medical necessity for Medi-Cal reimbursement, and comply with all State and County documentation and billing requirements.
Run reports from the designated electronic health record (EHR) to assist program in complying with County and state documentation and billing requirements, perform data validation, and conduct quality control checks.
Provide oversight and track all billing and coding corrections to ensure accurate and timely billing for designated program/ program staff.
Interpret and apply complex insurance contract terms to determine appropriate reimbursement
Work closely with clinical staff, programs and billing department to resolve billing issues and ensure smooth operations.
Serve as a Medi-Cal billing expert for CRF program staff. Provide consultation and feedback to program management and direct care staff regarding accurate billing and documentation practices.
Verify patient insurance eligibility and benefits for Medicare and Medi-Cal.
Provide updates to management on claim billing status, trends and outstanding errors.
Maintain a high level of confidentiality.
Review, correct, and submit complex claims with a focus on accuracy, timeliness, and payer-specific requirements.
Track and analyze denial rates, initiating corrective actions to reduce rejections and improve reimbursement.
Accurately code and post Medicare Remittance Advice, ensuring complete and compliant documentation.
Analyze reimbursement trends, payer behavior, and billing performance to identify opportunities for revenue enhancement.
Deliver actionable insights and strategic recommendations to senior leadership through data-driven reporting.
Partner with finance and compliance teams to ensure billing data aligns with broader organizational metrics and goals.
Ensure full adherence to HIPAA, CMS, Medi-Cal, and other payer-specific regulations.
Serve as a subject matter expert on billing regulations, payer requirements, and industry best practices.
Qualifications
Experience in Behavioral Health medical billing, particularly with Medi-Cal and managed care
Strong analytical and problem-solving skills
Previous experience with medical coding
Highly detail-oriented and organized
Knowledge of healthcare billing, payer requirements, and insurance claim processing
Familiarity with healthcare IT systems, including interfaces and integrations.
Strong communication and interpersonal skills.
Experience: 3-5 years of experience in a mental health setting, including one year of experience generating reports, data analysis, auditing, and compliance.
Education Required: High School diploma or equivalent required
Seniority level: Mid-Senior level | Employment type: Full-time | Job function: Health Care Provider | Industries: Mental Health Care
Referrals increase your chances of interviewing at Apex Recovery Rehab by 2x
Get notified about new Medical Biller jobs in
San Diego, CA .
Spring Valley, CA $23.00-$25.00 6 days ago
#J-18808-Ljbffr