MEDICAL BILLER W/ CALIFORNIA INSURANCE EXPERIENCE (BILINGUAL SPANISH - ENGLISH)

[ Kindly submit your updated English resume ] We are seeking a highly skilled Full-Cycle Medical Biller with extensive experience in U.S. healthcare billing, particularly within California insurance systems. This role requires a deep understanding of the end-to-end billing cycle, including claim submission, payment posting, accounts receivable (A/R), and denial management. The ideal candidate is a proactive problem-solver who can independently navigate complex payer systems while also supporting front-office functions, including patient intake and communication. Key Responsibilities: • Manage the full-cycle medical billing process from claim creation to final payment resolution • Perform accurate claim submission and generation using ICD-10 and CPT coding • Handle payment posting , reconciliation, and adjustments • Monitor and manage Accounts Receivable (A/R) to ensure timely collections • Conduct denial management and follow-ups , including appeals and resubmissions • Perform insurance verification and eligibility checks • Process and manage prior authorizations for procedures and services • Navigate payer portals (e.g., Availity and payer-specific systems) for claims, eligibility, and follow-ups • Communicate with insurance providers regarding claim status, denials, and authorizations • Support front-office operations , including patient intake and insurance-related inquiries • Ensure compliance with medical necessity documentation and payer requirements • Collaborate with providers and internal teams to resolve billing discrepancies • 2+ years of end-to-end medical billing experience (REQUIRED) • Strong proficiency in: • Claim submission and generation • ICD-10 and CPT coding • Payment posting • A/R management • Denial handling and follow-ups • Extensive experience with: • Insurance verification and prior authorizations (REQUIRED) • Hands-on experience working with: • Medicare • Medicaid / Medi-Cal (or state equivalent) • Medicare Advantage plans • HMO plans in California (REQUIRED) • Deep familiarity with U.S. insurance portals (e.g., Availity, payer portals) • Strong understanding of medical necessity requirements • Excellent communication and problem-solving skills • Willingness to work in US time zones (PST, EST, CST). • High school diploma or equivalent. Preferred Qualifications • Experience working with Independent Physician Associations (IPAs) • Background in Primary Care and/or ENT (Ear, Nose, and Throat) specialties • Experience with DrChrono EHR (preferred but not required) System and Work Setup Requirements: • Internet : Minimum speed of 25 Mbps or higher, with a reliable backup connection available in case of power outages or service provider issues. • Processor : Intel Core i5 7th Generation or higher (or equivalent). • Memory : 8 GB RAM. • Storage : 256 GB SSD or HDD with at least 50% free space available. • Webcam : 720p resolution or higher. • Operating System : Windows 10 or later (or equivalent). • Audio Equipment : Noise-canceling earphones or headset. • Workspace : A designated, quiet, and organized workspace free from distractions to ensure productivity and focus. • Permanent remote work setup • Competitive starting rate paid in USD • Internet Allowance • HMO insurance (PH) • Paid US holidays • Paid Vacation and Sick Leaves