Billing Specialist II

JOB DESCRIPTION

Join our team at the Tuolumne Me-Wuk Indian Health Center, where we offer more than just a job -- we provide a community-focused environment with competitive salaries, exceptional benefits, and a true work-life balance.

Our comprehensive benefits package includes medical, dental, vision, and a 401(k) plan, ensuring you and your family are well cared for. Plus, take advantage of Indian Health Service Loan Forgiveness opportunities to advance your career while reducing your student debt.

Located in the heart of California’s Sierra Nevada foothills, our location offers not just a fulfilling career but the chance to explore a region full of stunning landscapes and outdoor recreation. Spend your days helping others grow professionally and your evenings and weekends hiking through serene mountain trails, kayaking on pristine lakes, or enjoying the charm of historic Downtown Sonora. With its vibrant culture, unique shops, and year-round festivals, you’ll find endless ways to connect and thrive.

Whether you’re seeking professional growth or outdoor excitement, Tuolumne County is the perfect place to build your future. Apply today and start your next adventure with us!

POSITION OVERVIEW:

Title:              Billing Specialist II

Reports To:    Billing Manager

Schedule:       M-F; 8am-5pm

Status:             Non-Exempt

Summary:       The Billing Specialist II role is an intermediate-level position and is responsible for processing of all encounters to ensure compliance with federal, state and payer specific guidelines. Provide the Billing Manager with monthly reports on the status of all third-party payor's activity including delinquent accounts, aging report of all accounts, and recommended write-off of accounts. Adherence to protocols will be in accordance with HIPAA regulation requirements.

PRIMARY RESPONSIBILITIES: (Will include but not limited to)

•         Responsible for billing appropriate payors for services rendered by > the Medi-Cal, dental, optometry, behavioral health or physical > therapy staff.

•         Maintains accountability and accuracy of all ICD 10/CPT coding > guidelines.

•         Oversees all investigations on missing ICD 10/CPT coding and works > with the coding team to ensure proper documentation and > reimbursement.

•         Responsible for conducting and completing all necessary patient and > insurance inquiries, appeals and refunds.

•         Ensure compliance with federal, state and payer-specific guidelines.

•         Electronically sends insurance claims on a regular basis and follows > up on claims to ensure proper adjudication.

•         Analyzes and summarizes all types of insurance denials and reports > any unusual findings to the Billing Manager.

•         Train and assist Billing Specialist I staff as needed.

•         Must have the ability to work in an independent and self-directed > manner and assume individual initiative.

•         Be familiar with the aims and objectives of the Health Center and > express a genuine enthusiasm for its success.

•         Regular and consistent attendance is an essential function of this > position.

•         Performs other duties as assigned.

QUALIFICATIONS:

•         High school diploma or GED.

•         Medi-Cal Billing Certificate preferred.

•         3-4 years of work experience in healthcare billing.

•         Optometry and Dental billing experience a plus.

•         Must have knowledge of Medi-Cal terminology and ICD 10/CPT Medi-Cal

coding.

•         Experience working multiple EHR software systems is preferred.

•         Knowledge of all insurance billing procedures and guidelines

including Medicare, Medi-Cal, private insurance.

•         Experience with and the ability to operate Microsoft Office software

is required.

•         Must possess sufficient written and verbal communication skills to

be able to interact with Medi-Cal professionals, patients and peers

in a professional manner.

•         Excellent customer service skills, including good communication and

strong interpersonal skills.

•         Must have the ability to work in a fast-paced and sometimes

stressful environment.

•         Must have the ability to work in an independent and self-directed

manner and assume individual responsibility.

•         Must have a general knowledge of and ability to maintain HIPAA

privacy requirements and sign a confidentiality agreement.

PHYSICAL REQUIREMENTS:

This position requires walking, standing, and sitting for prolonged periods of time; climbing stairs, step-stools, ladders, etc.; stooping, kneeling, crouching, crawling, balancing, and reaching; pushing, pulling and lifting up to 50 pounds; raising objects overhead; manual dexterity for operation of computer and phones; hearing, talking, and good verbal and written communication skills; repetitive motions of the wrists, hands, and fingers; subject to outside environmental conditions of heat and cold; walking on uneven ground; operation of medium-weight equipment. This position requires the ability to safely operate a motor vehicle.

EQUAL OPPORTUNITY AND INDIAN PREFERENCE:

Tuolumne Me-Wuk Indian Health Center is an Equal Opportunity Employer committed to providing a diverse and inclusive workplace.

In accordance with the Indian Preference Act (25 U.S.C. §§ 472 & 473) and Public Law 93-638, qualified Native American and Alaskan Native applicants will be given preference, provided appropriate documentation is submitted. In-house postings also include Tribal Voting Members.

All positions require cultural sensitivity and the ability to interact respectfully and effectively with diverse tribal communities.

Employment is contingent upon successful completion of a pre-employment TB test, background check, and drug screening.