Billing Clerk Specialist

Pay Rate: $21.00-$29.00/hour DOE
Schedule: Monday-Friday, 8:00 AM - 4:30 PM
Location: Alpine, CA

Responsibilities

• Review and validate charge batches, including pre-coding, within the PM/EHR system.
• Ensure all provider-generated charges are accurately received and accounted for.
• Verify patient eligibility, authorizations, and insurance details within the PM system.
• Confirm complete documentation for new patients and specialty programs (Grants, PRC, Direct), including demographics, insurance, and claim information.
• Apply CPT, ICD-10 codes, and modifiers accurately for all billable services.
• Process claims daily, resolving edits and addressing rejections through the clearinghouse.
• Collect outstanding balances from insurance carriers and patients.
• Create EFT and fiscal batches; post insurance and patient payments accurately.
• Prepare, review, and distribute weekly patient statements.
• Establish and manage patient payment plans.
• Monitor unpaid claims and follow up to ensure timely resolution.
• Submit additional documentation to support reimbursement when required.
• Organize and maintain documentation for claims follow-up.
• Analyze EOB and ERA remittance codes to identify denials and zero payments.
• Follow up with payers regarding claim status and routing issues.
• Communicate payer concerns, trends, and issues to the Billing and Coding Supervisor to support timely resolution and reimbursement.
• Document all account follow-up activities thoroughly.
• Maintain flexibility in scheduling based on operational needs.

Other duties as assigned.

Candidate Profile

• Certificate from a medical institution or Associate degree (AA/AS) required.
• Minimum of two (2) years of experience in medical, dental, pharmacy, or behavioral health preferred.
• Prior billing and collections experience strongly preferred.
• Knowledge of medical terminology, anatomy and physiology, and coding systems including CPT, HCPCS, and ICD-10 required.
• Experience with IHS/FQHC settings preferred.
• Familiarity with NextGen Healthcare EHR/EMR systems is a plus.
• Valid California driver's license required at time of application and must be maintained throughout employment. Must be insurable under SIHC vehicle insurance policy.
• Relevant certifications and/or licenses appropriate to the role required.

Additional Requirements

• Background Check: 7-year background screening
• Drug Screen