Billing Specialist in SAN MARCOS, California at Palomar Health Palliative & Hospice

Schedule: Part-time (Monday-Friday, 4pm-8pm with occasional Saturdays based on business needs)

Compensation: Starting compensation range of $25.00 hourly. Exact compensation will be determined by experience, education, licensure/certifications, and location, in accordance with applicable laws.

Position Overview

The Non-Medicare Billing Specialist manages the full billing and collections cycle for all of Circle of Care Hospice LLC’s non-Medicare payers, including managed Medi-Cal plans, commercial insurers, Veterans Affairs / TriWest, and other managed-care organizations. In this role you are responsible for accurate and timely claim submission, diligent follow-up on outstanding balances, and resolution of denials and underpayments—with a particular focus on preventing timely-filing write-offs and reducing aged accounts receivable. You work independently, communicate clearly with payers, and apply a strong working knowledge of hospice room-and-board and managed-care billing requirements.

Responsibilities

Claim Submission & Billing

• Prepare, review, and submit clean claims to all non-Medicare payers (managed Medi-Cal, commercial, VA/TriWest, and managed-care plans) within each payer’s timely-filing deadline.
• Verify patient eligibility, plan enrollment, authorizations, and coordination-of-benefits before billing to ensure claims route to the correct payer.
• Accurately bill hospice room-and-board and per-diem charges in accordance with each plan’s contract terms and rates.
• Maintain billing setup so that patients who change coverage (e.g., straight Medi-Cal to a managed plan) are billed correctly and promptly.

Collections & AR Follow-Up

• Monitor the non-Medicare aging report and proactively work outstanding balances, prioritizing claims approaching filing or appeal deadlines.
• Follow up with payers by phone and portal on unpaid, pending, and underpaid claims; document all contacts, reference numbers, and next steps in the billing system.
• Reduce aged receivables across the Over-60, Over-90, and Over-120 buckets and report progress regularly.

Denials, Appeals & Resolution

• Research, correct, and resubmit denied or rejected claims, identifying root causes such as authorization, eligibility, coding, or timeliness issues.
• Prepare and submit timely appeals with supporting documentation, tracking each through to resolution.
• Escalate systemic payer issues, enrollment/credentialing gaps, or contract discrepancies to management.

Reporting & Compliance

• Post and reconcile payments, adjustments, and write-offs accurately.
• Flag and document accounts that are genuinely uncollectible, with clear notes supporting each determination.
• Maintain patient and payer information in compliance with HIPAA and company policies.

Perform other job-related duties as assigned.

• 2+ years of medical billing and collections experience, including non-Medicare/managed-care payers.
• Working knowledge of managed Medi-Cal, commercial, and VA/TriWest claim requirements and timely-filing rules.
• Experience with claims submission and payer portals (e.g., Availity) and clearinghouse workflows.
• Strong understanding of denials management, appeals, EOB/ERA interpretation, and coordination of benefits.
• Excellent organization, documentation, and follow-through; able to work independently and manage priorities part-time.
• Proficiency with billing software and spreadsheets; high attention to detail and accuracy.

Preferred

• Prior hospice or home-health billing experience, including room-and-board billing.
• Familiarity with California managed Medi-Cal plans (e.g., Molina, IEHP, CalOptima, Community Health Group, Blue Shield Promise).
• Knowledge of hospice levels of care and per-diem reimbursement.

Work Environment & Physical Requirements

• Ability to perform job duties effectively in a remote work environment while maintaining professionalism, productivity, and confidentiality.
• Regular use of computers, phones, and other technology for documentation, communication, virtual meetings, and electronic medical records.
• Ability to sit and work at a computer for extended periods and perform repetitive hand movements such as typing and data entry.
• Visual and hearing ability sufficient to communicate effectively and review electronic information.
• Ability to manage multiple priorities independently in a remote setting with minimal supervision.
• Reliable internet connection and a secure, distraction-limited workspace appropriate for handling confidential information in compliance with HIPAA
• May require occasional travel for meetings, training, or other business needs.
• Ability to manage the emotional aspects of supporting patients and families in an end-of-life care environment.

About Palomar Health Palliative & Hospice

Palomar Health Palliative & Hospice is dedicated to a patient-first mission, ensuring compassionate, high-quality care that supports patients and families through every stage of need. Our culture is defined by data-driven excellence, operational transparency, and a steadfast commitment to its core values of Dignity, Integrity, Compassion, Excellence and Partnership. With an expanding network through partnerships, Palomar Health Palliative & Hospice is positioned for continued growth and innovation as it scales to new markets.

Palomar Health Palliative & Hospice is an equal opportunity employer and is committed to a policy of equal employment opportunity for all employees and applicants. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status in accordance with applicable federal, state, and local laws. All employment decisions are based on job requirements, individual merit, and business need.