Billing Specialist

Position Overview A successful Billing Specialist must be passionate about healthcare and driven to make a difference in the lives of others, serving as a mission-focused catalyst to help Livingston Community Health deliver the highest quality of care and exceptional service to our patients and their families. The Billing Specialist is responsible for accurate and timely billing, claim submission, and payment posting for services provided. This role ensures compliance with HRSA, Medi-Cal, Medicare, and managed care billing requirements, supports revenue integrity, and works collaboratively with clinical and administrative teams to resolve billing issues and reduce claim denials. By maintaining compliant billing and payment posting practices, the role supports LCH's financial sustainability and ability to provide affordable care to our community. Essential Functions, Duties, and Responsibilities Billing & Claims Processing Prepares, reviews, and submits claims for Medi-Cal (including FQHC PPS), Medicare, Medicare Advantage, and commercial managed care plans. Ensures claims comply with HRSA, CMS, and state-specific FQHC billing requirements. Applies correct CPT, HCPCS, ICD-10, and modifier coding in accordance with FQHC guidelines. Verifies encounter eligibility, covered services, and required documentation prior to billing. Submits corrected, adjusted, and voided claims as needed. Payment Posting & Reconciliation Posts payments, adjustments, and denials accurately and timely. Reconciles remittance advice (EOBs/ERAs) to claims submitted. Identifies underpayments, overpayments, and contractual variances and escalates appropriately. Processes refunds and credit balances in compliance with payer and organizational policies. Denials & Follow-Up · Reviews and analyzes claim denials and rejections. · Initiates appeals and provides supporting documentation as required. · Tracks denial trends and communicates issues to leadership for process improvement. · Follows up on unpaid or underpaid claims to ensure timely reimbursement. Compliance & Reporting · Maintains compliance with HRSA, CMS, Medi-Cal, and managed care billing regulations. · Supports audits, site visits, and reviews by maintaining accurate billing records. · Assists with monthly billing, aging, and productivity reports. · Protects patient confidentiality and complies with HIPAA regulations. Collaboration & Communication · Works closely with front office, clinical staff, coding, and eligibility teams to resolve billing discrepancies. · Provides guidance to staff regarding billing requirements and documentation needs. · Communicates professionally with payers, vendors, and internal departments. Respond promptly to provider and patient inquiries with exceptional customer service. Supports the overall needs of the organization by working flexible or extended hours when necessary. Demonstrates competence with the mission, vision, and values of the organization in providing quality services to the community. Other work-related duties as assigned. Duties and responsibilities may be added, deleted, or changed at any time at the direction of leadership, formally or informally, either verbally or in writing. Maintains confidentiality and respect for all sensitive information. Displays a positive, professional, and respectful demeanor at all times towards employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for LCH. Contributes as part of the finance team by promoting positive staff interactions and maintaining open communication with other programs and departments. Attends and actively participates in all meetings (e.g., department meetings, program meetings, staff meetings) and other activities as required or assigned Education, Knowledge, Skills, and Abilities: Education and Experience High school diploma or equivalent required Associate's degree in Health Information Management or Medical Billing Certification preferred. Minimum 1-2 years hands-on medical billing experience in an FQHC or similar healthcare setting required. Knowledge, Skills, and Abilities Knowledge of CPT, ICD-10, HCPCS, modifier usage, and payer billing requirements. Working knowledge of FQHC PPS/APM methodologies, sliding-fee discount programs, and UDS reporting. Demonstrated skills with Medi-Cal, Medicare, managed care, and commercial payers. Proficient in medical billing software and EHR systems (e.g., NextGen, eClinicalWorks, Athena). Familiarity with ERAs, EOBs, and payer-specific remittance processes. Excellent data entry accuracy, organizational skills, and attention to detail. Ability to work independently and as part of a team. Effective written and verbal communication skills. Ability to manage multiple tasks and meet deadlines. High attention to detail and strong analytical and problem-solving abilities. Strong customer service and interpersonal skills. Ability to foster collaborative relationships within and across departments. Ability to assess and respond to issues promptly and professionally. Ability to provide training and support to team members as requested. Proficient in Microsoft Word, Excel, and practice management systems. Must know 10-key by touch. Solid understanding of HIPAA regulations and healthcare data confidentiality standards. Ability to work extended hours during close-out/reconciliation periods.