Billing Specialist

Position Overview A successful Billing Specialist must be passionate about healthcare and driven to make a difference in the lives of others, serving as a mission-focused catalyst to help Livingston Community Health deliver the highest quality of care and exceptional service to our patients and their families.

The Billing Specialist is responsible for accurate and timely billing, claim submission, and payment posting for services provided.

This role ensures compliance with HRSA, Medi-Cal, Medicare, and managed care billing requirements, supports revenue integrity, and works collaboratively with clinical and administrative teams to resolve billing issues and reduce claim denials.

By maintaining compliant billing and payment posting practices, the role supports LCH's financial sustainability and ability to provide affordable care to our community.

Essential Functions, Duties, and Responsibilities Billing & Claims Processing Prepares, reviews, and submits claims for Medi-Cal (including FQHC PPS), Medicare, Medicare Advantage, and commercial managed care plans.

Ensures claims comply with HRSA, CMS, and state-specific FQHC billing requirements.

Applies correct CPT, HCPCS, ICD-10, and modifier coding in accordance with FQHC guidelines.

Verifies encounter eligibility, covered services, and required documentation prior to billing.

Submits corrected, adjusted, and voided claims as needed.

Payment Posting & Reconciliation Posts payments, adjustments, and denials accurately and timely.

Reconciles remittance advice (EOBs/ERAs) to claims submitted.

Identifies underpayments, overpayments, and contractual variances and escalates appropriately.

Processes refunds and credit balances in compliance with payer and organizational policies.

Denials & Follow-Up · Reviews and analyzes claim denials and rejections.

· Initiates appeals and provides supporting documentation as required.

· Tracks denial trends and communicates issues to leadership for process improvement.

· Follows up on unpaid or underpaid claims to ensure timely reimbursement.

Compliance & Reporting · Maintains compliance with HRSA, CMS, Medi-Cal, and managed care billing regulations.

· Supports audits, site visits, and reviews by maintaining accurate billing records.

· Assists with monthly billing, aging, and productivity reports.

· Protects patient confidentiality and complies with HIPAA regulations.

Collaboration & Communication · Works closely with front office, clinical staff, coding, and eligibility teams to resolve billing discrepancies.

· Provides guidance to staff regarding billing requirements and documentation needs.

· Communicates professionally with payers, vendors, and internal departments.

Respond promptly to provider and patient inquiries with exceptional customer service.

Supports the overall needs of the organization by working flexible or extended hours when necessary.

Demonstrates competence with the mission, vision, and values of the organization in providing quality ser...