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:

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

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

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Memory : 8 GB RAM.

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

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Webcam : 720p resolution or higher.

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

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Audio Equipment : Noise-canceling earphones or headset.

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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

Originally posted on Himalayas