Billing Specialist - Medicare

Breg - Carlsbad, CA (30+ days ago)2.9

Are you looking for an exciting opportunity?

We currently have a direct-hire, full-time openings for a Billing Specialist – Medicare in Carlsbad, CA. If you are looking for a fast paced environment where you can make a difference every day, then this is the opportunity for you! The Billing Specialist – Medicare is responsible for LCD chart review primarily for Medicare and other payers as required. S/he will be primarily responsible for conducting clinical reviews of medical records or other program integrity initiatives such as requests for information or in support of proactive data analysis efforts. Medicare guidelines will be applied in making clinical determinations as to the appropriateness of payment coverage. S/he will interact with case managers, third party administrators, payer representatives, patients, customer care representatives and sales representatives.

Your day will be very busy… you will:
Manages claims process including in-take, claim submission and accounts receivable activities for Breg’s in-house billing programs, primarily for Medicare.

Reviews information contained in Standard Claims Processing System (e.g., claims history, provider files) to determine provider billing patterns in Medicare/ other payer payment policies.

Utilizes Medicare and Contractor guidelines for coverage determinations. Utilizes extensive knowledge of medical terminology, ICD-10-CM, HCPCS Level II along with analysis and processing of Medicare/ other payer claims.

Provides training to Billing team in PSC locations and in India along with Training & Quality team on medical terminology, reading medical records, new guidelines and policy interpretation etc.

Coordinates and compiles the written Investigative Summary Report to the PI Investigator upon completion of the records review for submitting Redetermination/Appeals with Insurance

Completes assignments in a manner that meets the quality assurance goal of 100% accuracy.

Contacts insurance carriers to verify coverage of certain items. Relays information back to the account regarding the status.

Contacts third party payers, physicians’ personnel, sales representatives, and patients to resolve billing, reimbursement, and payment problems.

Serves as an advocate for reimbursement by Medicare/Third party payers.

Maintains related files and records in accordance with company and regulatory requirements and practice.

The right person to join our team is...

A dependable, honest, hard-working person who enjoys teamwork and is a positive influence on others. Someone who is detail oriented, focused on accuracy, can follow systems, is able to multi-task and communicate effectively.

What your background will be:
Associates degree or trade certificate in an applicable field of study and 2+ years relevant experience, or equivalent combination of education and experience.
Coding certification from AAPC/AHIMA or reputed institute is preferred.
Certification related to Medicare claims processing is preferred.
Proficiency in reimbursement principles, medical terminology, payer groups and networks including Medicare, worker’s compensation and private insurance is highly recommended.
Computer proficiency to include web browser/internet search, MS Outlook, Word and Excel is required. Technical competence includes the ability to learn new software and systems.
Knowledge of working in Billing Software applications is preferred.

What we can offer you...

Our insurance benefits are effective the 1st of the month after your hire date.

Medical /Dental /Vision plans
PTO (paid time off)
Holiday Pay
Life Insurance / STD / LTD

Work Schedules include….

Shift Hours – 7:00AM to 3:30PM or 7:30AM to 4:00PM.
Travel – less than 10%.
Flexible to adjust the shift timings/work for extended hours/weekends based on business needs.

For three years in a row Breg has been awarded The National Business Research Institute (NBRI) Circle of Excellence Award for employee engagement AND Breg has been awarded as one of the Best Places to work in San Diego in 2014 by “The U-T San Diego Top Workplaces”

If you meet the requirements above and would like to apply for this position, please visit our website at and click on the ‘Careers’ section.

Breg is an Equal Employment Opportunity Employer and dedicated to a diverse work force and Drug Free work environment. EOE/Minorities/Females/Vet/Disabled are encouraged to apply.