Managed Care Biller in Santa Fe Springs, CA at Pipeline Health Los Angeles

Date Posted: 7/19/2021

Job Snapshot

Job Description

Central Business Office

Job Title: Managed Care Biller 

City: Santa Fe Springs / State: California    

Central Business Office

Day Shift

From 8:00 AM

To 4:30 PM


Job Description and Job Responsibilites

Job Summary:  Responsible for billing all Non-Government claims accurately and timely. Must have knowledge in Government and State billing laws. Knowledge in CPT,ICD-9 and HCPCS codes is a requirement. Submit re-bills for corrected claims, and work billing denial reports within 24 hours from our clearing house systems. Required to document accounts financial systems accurately and timely.


Reports To: Managed Care Manager and or CBO Director

Essential Job Duties:  

  • Demonstrates competency and knowledge in managed care insurance billing, collections and contracts.
  • Reviews and updates accounts with correct payor codes, insurance addresses and financial classes.
  • Responsible to request medical records for billing purposes in a timely manner.
  • Knowledge in billing and or re-billing of claims through E-premis.
  • Demonstrates competency and knowledge in billing secondary plans.
  • Knowledge in billing cost pass thru invoices and late charges.
  • Demonstrates ability to identify and correct any missing information on claims.
  • Demonstrates ability to identify missing charges and request a detailed audit on claims. 
  • Ability to document AS400 system with account activity.
  • Ability to combine charges when needed on CMS system.
  • Demonstrates ability and knowledge in resolving outstanding balances owed on managed care claims.
  • Demonstrates knowledge and understanding of managed care contracts.
  • Ensures contractual discounts are applied to accounts as specified in each contract.
  • Able to apply contract language to each claim as needed for reimbursement calculations/Review Explanation of Benefits.
  • Knowledge and experience working with Microsoft Word and Excel programs to create spreadsheets when necessary.
  • Ensures contractual adjustments are submitted timely by month end, including capitated accounts.
  • Work correspondence timely (within 24 hours)
  • Retrieve necessary documents in the HBF system for billing
  • Demonstrates full knowledge on interpreting an Explanation of Benefits and identify patient financial responsibility.
  • Knowledge and experience in processing refund requests.
  • Notifies supervisor of any issues or problems.
  • Consistently meets billing goals per department guidelines.
  • All other duties and projects as assigned.

Behavioral Standards: 

  • Exhibits customer and service oriented behaviors in every day work interactions.
  • Demonstrates a courteous and respectful attitude to internal workforce and external customers.
  • Communicates accurately and appropriately.
  • Works well and efficiently under minimal supervision.
  • Handles difficult situations in a discreet and professional manner.
  • Is adaptable to changes in assignments and priorities.


  • Provides accurate and timely written and verbal communication of information in a manner that is understood by all.  
  • Able to listen, understand, problem-solve, and carry-out duties to ensure the optimal outcome.
  • Able to use IT systems in an accurate and proficient manner.


  • Contributes toward effective, positive working relationships with internal and external colleagues.
  • Demonstrates cooperation, flexibility, reliability, and dependability in all daily work activities and a willingness to collaborate with others for the good of the customer and the organization. 

Job Requirements


  • High school graduate or equivalent required
  • Prefer at least 2 to 3 years of current experience in an acute care hospital setting
  • Must be able to multi-task and work in a fast past environment


  • N/A

ADA/Physical Demands:

  • To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed are representative of the knowledge, skill, and/or ability required.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant in order to be considered.
  • Required to stand; walk; sit; use hands to fingers, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; talk and hear; and may taste and smell.  The employee is regularly required to lift, push and/or pull weights in excess of 10 pounds, with assistance. Visual abilities, auditory abilities, must be intact to perform duties.