Location: SF Bay Area, CA (Onsite - 5 days/week)
Employment Type: Full-Time, Permanent
Compensation: Competitive base salary + annual bonus + full benefits
About Us: We are a forward-thinking medical technology and healthcare services organization focused on enhancing patient care through innovative technology-driven programs. Join our team and play an integral role in optimizing reimbursement processes across professional medical billing, payer engagement, and revenue cycle operations.
Your Impact: As a Lead Medical Billing Specialist, you will take ownership of essential billing processes, ensuring compliance and efficiency while collaborating with various teams. This role suits detail-oriented professionals who are passionate about driving improvements in healthcare reimbursement.
Key Responsibilities:
- Conduct thorough insurance eligibility and benefits verification through direct payer outreach.
- Manage the full medical billing lifecycle, encompassing charge entry, claim submission (CMS-1500 / 837), payment posting, AR follow-up, appeals, and resolution of denials.
- Interpret and implement Medicare, Medicaid, and commercial payer policies to improve billing operations.
- Monitor accounts receivable aging, analyze reimbursement trends, and identify areas for improvement.
- Create and sustain billing, reimbursement, and performance reports to guide operational and financial strategies.
- Lead audits and data clean-up activities to uphold billing precision and regulatory compliance.
- Develop and execute strategies to enhance first-pass claim acceptance rates and minimize revenue loss.
- Collaborate with technology and internal teams to refine billing workflows and reporting capabilities.
- Maintain thorough documentation of billing operations, payer interactions, and process revisions.
- Provide training and support for billing-related inquiries to team members and partners.
- Ensure compliance with HIPAA and healthcare billing regulations.
- Assist with invoice distribution, payment tracking, and resolving billing discrepancies.
- Support continuous improvement initiatives within the revenue cycle function.
Qualifications:
- Bachelor's degree in healthcare administration, finance, accounting, business, or a related field.
- 5+ years of hands-on experience in professional medical billing or revenue cycle operations.
- Comprehensive knowledge of CPT, ICD-10, and HCPCS coding practices.
- Experience with EHR / Practice Management Systems and billing software.
- Solid understanding of payer reimbursement models, AR management, and denial resolution processes.
- Ability to produce and interpret reimbursement and aging reports.
- Exceptional attention to detail with strong analytical and problem-solving capabilities.
- Ability to manage multiple priorities in a dynamic environment with minimal supervision.
- Outstanding written and verbal communication skills with a focus on customer service.
- Proficiency in Microsoft Office (Excel, Word, PowerPoint) and Google Workspace (Docs, Sheets, Slides).
What's in it for You:
- Full-time, permanent position with a stable and collaborative work environment.
- Competitive salary plus an annual performance-based bonus.
- Comprehensive medical, dental, vision, and wellness benefits.
- Generous paid time off and holidays.
- An opportunity to directly impact patient access and enhance organizational performance.