Medical Biller II (Bilingual Spanish or Vietnamese Required) at FAMILIES TOGETHER OF ORANGE COUNTY – Tustin, California

Job Title: Medical Biller II

Salary: $25hr-$28hr DOE

Location: Tustin, CA

Openings: 1

Position Purpose: The Medical Billing Specialist II supports the revenue cycle team by independently performing a broad range of billing functions with moderate complexity. This role is responsible for accurate insurance verification, charge entry, claim submission, payment posting, and resolution of routine denials to ensure compliance with payer requirements and timely reimbursement.

Core Duties and responsibilities, include but are not limited to:

Insurance & Eligibility Verification

• Verify complex insurance coverage (Medi-Cal, Medicare, Managed Care, Commercial, PPO/HMO).
• Research and resolve discrepancies in patient coverage or eligibility.
• Document eligibility outcomes in the EHR/PM system.

Charge Entry & Coding Support

• Perform charge entry and apply CPT, ICD-10, and HCPCS codes.
• Review encounter forms for accuracy; flag missing or incorrect documentation for provider follow-up.
• Apply modifiers and place-of-service codes where appropriate.

Claims Processing

• Submit clean claims through the clearinghouse; correct rejections requiring payer-specific edits.
• Monitor claim acceptance and rejection reports; take corrective action promptly.
• Escalate high-dollar or complex denials to Specialist III or Lead.

Payment Posting & Reconciliation

• Post payments from ERA/EOBs and reconcile with patient accounts.
• Apply contractual adjustments and record secondary payments.
• Assist in balancing daily batches and preparing reconciliation logs.

Patient Accounts & Customer Service

• Respond to patient billing inquiries with professionalism and accuracy.
• Set up and monitor payment plans; explain insurance coverage and patient responsibility.
• Escalate disputes, sliding fee scale requests, or hardship cases to senior billing staff.

Reporting & Analysis

• Generate A/R aging reports, claim status reports, and denial trend summaries.
• Identify recurring claim errors and communicate with the supervisor for process improvement.

Collaboration & Compliance

• Communicate with providers, front desk, and registration staff regarding documentation and insurance data accuracy.
• Adhere to compliance guidelines for timely filing, HRSA/FQHC billing rules, and payer-specific requirements.
• Participate in internal audits and provide supporting documentation as needed.

*This job description in no way states or implies that these are the only duties to be performed by the employee. He or she will be required to follow any other instructions and to perform other duties, within scope, as assigned by his or her supervisor.

Education, Qualifications, and Experience:

• Education: High school diploma or equivalent required.
• 2+ years of medical billing experience (FQHC or primary care strongly preferred)
• Working knowledge of CPT, ICD 10, and HCPCS coding.
• Experience with EHR/PM systems (e.g., NextGen, eClinicalWorks, EPIC, etc.).
• Attention to detail, strong organizational skills, and ability to meet deadlines.
• Excellent communication and customer service skills.

Work Schedule:

• FTOC is an in-person organization first, and foremost. Employees are expected to be on-site for their scheduled shifts.
• Hours of operation are Monday to Friday 8 a.m. to 8 p.m., however, employee schedules vary, depending on organizational, staffing, community, and patient needs. As such, FTOC may need to modify work schedules to meet such needs.
• Holidays and weekends may be required depending on an employee’s department due to organizational, staffing, community, and patient needs as FTOC continues to grow and expand work days and hours.
• Overtime may also occur due to organizational, staffing, community, and patient needs.

Travel Requirements:

• Occasional travel will be required for this position. Must be able to travel to FTOC sites as needed, including short notice.

Physical Demands and Working Conditions:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee may be required to drive to FTOC facilities as needed. The ability to sit for extended periods of time, and the ability to occasionally lift and/or move up to 25 pounds.