Senior Billing Specialist in Oakland, California at Roots Community Health Center

Position Summary:

The Senior Billing Specialist is responsible for accounts receivable follow-up, denial

management, and payment posting to maximize reimbursement and ensure timely

resolution of outstanding claims. This position focuses primarily on Alameda Alliance,

Medicare, and Medi-Cal claims and supports training of front desk staff, new hires, and

interns as needed. The position reports directly to the Billing Manager.

Duties and Responsibilities:

• Review paper and electronic remittance advices (ERAs), explanation of benefits (EOBs), and denial notices.
• Post insurance payments and contractual adjustments accurately in AdvancedMD.
• Conduct accounts receivable follow-up on billed claims to ensure timely payment.
• Research denied or underpaid claims and take corrective action toward resolution.
• Correct claim errors and resubmit claims to payers as appropriate.
• Investigate payment delays and unresolved claims to maximize reimbursement.
• Review and update patient demographics, insurance plans, and carrier information.
• Verify insurance eligibility and PCP assignment when necessary.
• Maintain accurate demographic and insurance information in the electronic health record and billing system.
• Monitor and report denial trends and reimbursement issues to the Billing Manager.
• Participate in internal chart audits, billing audits, and compliance activities.
• Implement payer billing guidelines, policies, and procedures.
• Support front desk training as needed, including the development of tip sheets and desk references to assist the Patient Services Department.
• Assist with onboarding and training of new hires and interns as needed.
• Attend staff meetings, supervision sessions, and required trainings.
• Complete assigned documentation and reports in a timely manner.
• Perform other related duties as assigned.

Qualifications and Competencies:

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
• Minimum of three (3) years of experience in medical billing, payment posting, or accounts receivable follow-up.
• Experience working with Medicare, Medi-Cal, and managed care payers, including Alameda Alliance for Health.
• Strong knowledge of insurance denials, appeals, and payer billing guidelines.
• Proficiency in Electronic Health Records and practice management systems, preferably AdvancedMD.
• Knowledge of medical terminology and healthcare reimbursement principles.
• Strong analytical, organizational, and problem-solving skills.
• Ability to train and support staff in registration and billing-related workflows.
• Experience working in a nonprofit or community health center setting preferred.