Medical Biller w/ California Insurance Experience (Bilingual Spanish - English)

[Kindly submit your updated English resume]

We are seeking a highly skilled Full-Cycle Medical Biller with extensive experience in U.S. healthcare billing, particularly within California insurance systems. This role requires a deep understanding of the end-to-end billing cycle, including claim submission, payment posting, accounts receivable (A/R), and denial management.

The ideal candidate is a proactive problem-solver who can independently navigate complex payer systems while also supporting front-office functions, including patient intake and communication.

Key Responsibilities:

• Manage the full-cycle medical billing process from claim creation to final payment resolution

• Perform accurate claim submission and generation using ICD-10 and CPT coding

• Handle payment posting, reconciliation, and adjustments

• Monitor and manage Accounts Receivable (A/R) to ensure timely collections

• Conduct denial management and follow-ups, including appeals and resubmissions

• Perform insurance verification and eligibility checks

• Process and manage prior authorizations for procedures and services

• Navigate payer portals (e.g., Availity and payer-specific systems) for claims, eligibility, and follow-ups

• Communicate with insurance providers regarding claim status, denials, and authorizations

• Support front-office operations, including patient intake and insurance-related inquiries

• Ensure compliance with medical necessity documentation and payer requirements

• Collaborate with providers and internal teams to resolve billing discrepancies

Requirements

• 2+ years of end-to-end medical billing experience (REQUIRED)

• Strong proficiency in:

• Claim submission and generation

• ICD-10 and CPT coding

• Payment posting

• A/R management

• Denial handling and follow-ups

• Extensive experience with:

• Insurance verification and prior authorizations (REQUIRED)

• Hands-on experience working with:

• Medicare

• Medicaid / Medi-Cal (or state equivalent)

• Medicare Advantage plans

• HMO plans in California (REQUIRED)

• Deep familiarity with U.S. insurance portals (e.g., Availity, payer portals)

• Strong understanding of medical necessity requirements

• Excellent communication and problem-solving skills

• Willingness to work in US time zones (PST, EST, CST).

• High school diploma or equivalent.

Preferred Qualifications

• Experience working with Independent Physician Associations (IPAs)

• Background in Primary Care and/or ENT (Ear, Nose, and Throat) specialties

• Experience with DrChrono EHR (preferred but not required)

System and Work Setup Requirements:

• Internet: Minimum speed of 25 Mbps or higher, with a reliable backup connection available in case of power outages or service provider issues.

• Processor: Intel Core i5 7th Generation or higher (or equivalent).

• Memory: 8 GB RAM.

• Storage: 256 GB SSD or HDD with at least 50% free space available.

• Webcam: 720p resolution or higher.

• Operating System: Windows 10 or later (or equivalent).

• Audio Equipment: Noise-canceling earphones or headset.

• Workspace: A designated, quiet, and organized workspace free from distractions to ensure productivity and focus.

Benefits

• Permanent remote work setup

• Competitive starting rate paid in USD

• Internet Allowance

• HMO insurance (PH)

• Paid US holidays

• Paid Vacation and Sick Leaves