医疗账单专员（有加州保险经验，双语西班牙语-英语）
Medical Biller w/ California Insurance Experience (Bilingual Spanish - English)
[请提交更新的英文简历]
我们正在寻找一位经验丰富的全周期医疗账单专员，具备美国医疗账单经验，特别是在加州保险系统方面。该职位需要深入了解整个账单流程，包括索赔提交、付款记录、应收账款（A/R）和拒付管理。
理想的候选人应是积极的问题解决者，能够独立处理复杂的支付方系统，同时支持前台功能，包括患者接待和沟通。
主要职责：
- 管理从索赔创建到最终付款解决的全流程医疗账单
- 使用ICD-10和CPT编码进行准确的索赔提交和生成
- 处理付款记录、对账和调整
- 监控和管理应收账款（A/R），确保及时回收
- 进行拒付管理和跟进，包括申诉和重新提交
- 执行保险验证和资格检查
- 处理程序和服务的前期授权
- 在支付方门户（如Availity和特定支付方系统）中处理索赔、资格和跟进
- 与保险公司沟通索赔状态、拒付和授权
- 支持前台运营，包括患者接待和保险相关咨询
- 确保符合医疗必要性文档和支付方要求
- 与提供者和内部团队合作解决账单差异
要求
- 2年以上全流程医疗账单经验（必须）
- 熟练掌握：
- 索赔提交和生成
- ICD-10和CPT编码
- 付款记录
- 应收账款（A/R）管理
- 拒付处理和跟进
- 广泛经验：
- 保险验证和前期授权（必须）
- 实际操作经验：
- 医疗保险（Medicare）
- 医疗补助（Medicaid/Medi-Cal）或同等州计划
- 医疗保险优势计划
- 加州HMO计划（必须）
- 熟悉美国保险门户（如Availity、支付方门户）
- 对医疗必要性要求有深入理解
- 优秀的沟通和解决问题能力
- 愿意在美国时区（PST、EST、CST）工作
- 高中毕业或同等学历
优先条件
- 有与独立医师协会（IPAs）合作的经验
- 具有初级护理和/或耳鼻喉科（ENT）背景
查看英文原文
[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
Originally posted on Himalayas