Medical Billing Specialist – FQHC, RHC, and Specialty Claims

Job Title: Medical Billing Specialist – FQHC, RHC, and Specialty Claims
Work Schedule: Monday – Friday
Schedule: 8:00 AM to 5:00 AM PST
Employment: Full Time

Job Overview:

We are seeking an experienced and detail-oriented Medical Billing Specialist to join our growing team. Our organization specializes in complex billing services for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and multidisciplinary clinics, requiring expertise in hospital-type billing. The ideal candidate must be proficient in handling UB-04 forms, specialty claims, dental claims, chiro claims, optometry claims, cardiology, nephrology, psychiatry, and more. This role requires deep knowledge of Medicare, Medicaid, Medi-Cal, and Dental-Cal billing, including RAP rates, managed care, secondary and tertiary insurance billing.

Key Responsibilities:

Process and submit UB-04 and CMS-1500 claims for various specialties including primary care, urgent care, wound care, telemedicine, pharmacy, optometry, dental, and more.
Ensure compliance with state and federal regulations, including Medicare, Medicaid, and managed care guidelines.
Accurately scrub, code, and validate claims prior to submission.
Handle denial management, appeals, and follow-ups with payers.
Manage secondary and tertiary billing, including RAP rates for Medicare and Medicaid.
Work with internal coders and scrubbers to ensure clean claims submission.
Coordinate with providers and administrative teams to resolve billing discrepancies.
Stay updated on changes in FQHC and RHC billing guidelines, ensuring compliance with regulatory requirements.
Utilize electronic health record (EHR) and billing systems for efficient claim processing.
Provide billing reports and analysis for revenue cycle improvement.

Qualifications:

Minimum of 3-5 years of experience in FQHC, RHC, hospital, or multi-disciplinary clinic billing.
Proficiency in UB-04 billing, managed care, and government payer requirements.
Experience with RAP billing, secondary and tertiary insurance billing.
Strong understanding of Medi-Cal, Medicaid, Dental-Cal, Medicare, and private payer systems.
Knowledge of billing software, EHR systems, and claims scrubbing tools.
Bilingual in English and Spanish preferred.
Ability to manage high-volume billing and work efficiently under pressure.
Strong analytical and problem-solving skills.
Certification in Medical Billing & Coding (CPC, CPB, or equivalent) preferred but not required.

Why Join Us?

Competitive salary and benefits package.
Opportunity to work with a leading multi-disciplinary clinic.
Collaborative and supportive team environment.
Room for professional growth and advancement.

If you have extensive experience in FQHC/RHC billing, hospital-level claim processing, and specialty claims, we encourage you to apply.

How to Apply: Submit your 1-2 mins video detailing your experience with FQHC, UB-04 billing, RAP rates, and specialty claims.
Do not apply if you don't have any experience handling these types of claims, don’t know anything about the Revenue Cycle Management. Please keep in mind that there is minimal training involved. There won’t be extensive training.