Medical Biller - Irvine, CA in Santa Ana, CA at Parallon

Date Posted: 4/28/2018

Job Snapshot

Job Description

The out of state Medicaid Biller is responsible for the timely submission of professional medical claims to out of state Medicaid agencies along with various health plans.

Essential Duties and Responsibilities:
  • Understanding Coding and ICD criteria
  • Knowledge of basic Medicaid billing rules, regulations, and deadline
  • Prepares and submits clean claims to various Medicaid agencies and or assigned payers
  • Using coded data to produce and submit claims
  • Working directly with the Medicaid agency to get the claim processed and paid.
  • Analyze remittance advice to ensure accurate posting of rejections, payments and contractual adjustments timely.
  • Reviewing and appealing unpaid and denied claims
  • Maintains a working knowledge of payer practices and reimbursement methodologies and becomes a subject matter expert in assigned A/R responsibilities.
  • Review UB/1500 claims for accuracy and completeness and obtain any missing information as needed for submission
  • Knowledge of out of state Medicaid billing guidelines
  • Check each insurance payment for accuracy and compliance with contract discount
  • Identify and bill secondary or tertiary insurances
  • Answer all client inquiries pertaining to assigned accounts
  • Understanding of Remittance Advise details for Medicaid
  • Other duties as needed.

Job Requirements


  • Minimum 2 years of experience in a medical office or healthcare business office; or equivalent combination of education and experience.
  • Working experience with all payer types including: commercial, governmental, Medicare, Medicaid, HMO, etc. and the ability to cross-over into different payers.
  • Established experience using Microsoft Excel, Microsoft Word and Microsoft Outlook is required.
  • Must have excellent verbal and written communication skills.
  • Understanding of co-pay, coinsurance, and deductibles and intermediate to expert experience in electronic claim submission and edit resolutions, third party payer insurance verification, collections and denial resolution process.
  • Medical Billing Certification preferred but not required.
  • High School Diploma or general education degree (GED) is required.

Skills or Other Qualifications Required:


•                      Excellent written and oral communication skills

•                      Extreme attention to detail and accuracy.

•                      Strong customer service skills required.

•                      General business office knowledge.

•                      Analytical ability a plus.

•                      Must be organized. 

•                      Ability to work well under pressure.

•                      Meet multiple and competing deadlines.

•                      The ability to type 45-55 WPM

•                      Ability to manage 10-key