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

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.

Permanent remote work setup

Competitive starting rate paid in USD

Internet Allowance

HMO insurance (PH)

Paid US holidays

Paid Vacation and Sick Leaves