Health Center Medical Biller I/II

Statement of Purpose

Under the direct supervision of the Health Center Operations Director. The Medical Biller I is responsible for supporting the revenue cycle by accurately preparing, submitting, and following up on medical claims for services rendered within a health center setting. This role ensures timely reimbursement while maintaining compliance with payer guidelines, FQHC billing requirements, and organizational policies. The Medical Biller I works collaboratively with clinical and administrative teams to resolve billing issues and support continuity of care.

Major Tasks, Duties and Responsibilities

• Prepare and submit accurate claims to Medi-Cal, Medicare, and commercial payers in a timely manner

• Review patient accounts for completeness, including insurance verification, coding, and required documentation

• Monitor claim status and follow up on unpaid, denied, or rejected claims

• Identify and resolve billing discrepancies, including eligibility issues and authorization requirements

• Post payments, adjustments, and denials accurately into the practice management system

• Assist with processing patient statements and responding to billing inquiries

• Maintain knowledge of FQHC billing requirements, including PPS and wrap-around payments

• Ensure compliance with federal, state, and payer-specific billing regulations

• Communicate with front office and clinical staff to correct or clarify billing information

• Maintain accurate and organized billing records for audit and compliance purposes

• Support month-end close processes and reporting as needed

• Participate in safety program to promote client and staff safety

• Maintain professional boundaries and standards of conduct

• Treat clients with respect, care, and concern at all times

• Maintain health and safety standards within the facility

• Recognize personal biases and demonstrate cultural sensitivity when working with diverse populations

• Attend meetings, trainings, and participate in committees as assigned

• Perform other duties as assigned

Medical Biller I Competencies and Performance Expectations

• Ability to complete the above major tasks, duties and responsibilities

• Ability to demonstrate professional judgment and decision-making

• Ability to adhere to professional standards

• Strong attention to detail and accuracy in data entry and claim submission

• Ability to manage multiple task and meet deadlines in a fast-paced environment

• Effective communication and problem-solving skills

• Ability to maintain confidentiality and handle sensitive patient information

• Team-oriented with a customer service mindset

Statement of Purpose

Under the direct supervision of the Health Center Operations Director. The Medical Biller II is responsible for performing advanced revenue cycle functions, including complex claim resolution, denial management, and ensuring accurate reimbursement for services rendered within a health center setting. This role supports timely reimbursement while ensuring compliance with payer guidelines, FQHC billing requirements, and organizational policies. The Medical Biller II works independently and collaboratively with clinical and administrative teams to resolve billing issues, improve processes, and support continuity of care.

Major Tasks, Duties and Responsibilities

• Prepare, review and submit accurate claims to Medi-Cal, Medicare, and commercial payers in a timely manner

• Perform detailed review of patient accounts for completeness, including insurance verification, coding, and required documentation

• Monitor claim status and follow up on unpaid, denied, or rejected claims

• Analyze and resolve billing discrepancies, including eligibility issues and authorization requirements

• Identify denial trends and implement corrective actions in collaboration with internal teams

• Post payments, adjustments, and denials accurately, ensuring appropriate follow-up and resolution

• Assist with processing patient statements and responding to billing inquiries

• Maintain knowledge of FQHC billing requirements, including PPS and wrap-around payments

• Ensure compliance with federal, state, and payer-specific billing regulations

• Communicate with front office and clinical staff to correct or clarify billing information

• Maintain accurate and organized billing records for audit and compliance purposes

• Support month-end close processes and reporting as needed

• Participate in safety programming to promote client and staff safety

• Maintain professional boundaries and standards of conduct

• Treat clients with respect, care, and concern at all times

• Maintain health and safety standards within the facility

• Recognize personal biases and demonstrate cultural sensitivity when working with diverse populations

• Attend meetings, trainings, and participate in committees as assigned

• Perform other duties as assigned

Medical Biller II Competencies and Performance Expectations

• Ability to complete the above major tasks, duties and responsibilities

• Ability to demonstrate professional judgment and decision-making

• Ability to adhere to professional standards

• High level of accuracy and attention to detail

• Strong analytical and problem-solving skills, with ability to identify trends and implement solutions

• Ability to manage multiple task and meet deadlines in a fast-paced environment

• Effective communication and problem-solving skills

• Ability to maintain confidentiality and handle sensitive patient information

• Team-oriented with a customer service mindset