Professional Insurance Biller

Department:

Employee Type:

Per Diem Type (if applicable):

Minimum Pay Range:

POSITION SUMMARY

The Professional Biller is vital to healthcare operations, responsible for managing all aspects of patient

billing, including claim processing, payments, and revenue cycle management. They serve as a liaison

between healthcare providers, patients, and insurance companies to ensure accurate, efficient billing

processes. Key duties include reviewing bills for accuracy, submitting and following up on insurance

claims, resolving discrepancies, and communicating with payers. They also are a resource regarding

patient inquiries, perform collection activities, and ensure compliance with privacy and billing

regulations. Staying informed of changing billing procedures and regulations is essential to maintain

efficient and compliant billing operations.

POSITION QUALIFICATIONS 

Education/Licensure/Certification: 

• High school diploma or GED required. 

Knowledge/Experience:  

• Minimum 3 years’ billing experience required. 

• Comprehensive working knowledge of medical terminology, CPT, HCPCS, ICD-10, insurance billing and appeals processes. 

• Knowledge and use of Office, PC, Microsoft Office, EHR, Epic billing software, and basic office equipment. 

• Current working knowledge of various Payers; Medicare, Medi-Cal, RHC, Commercial, workers compensation and other claims preferred 

• Understanding of governmental agencies, commercial insurances, state & county compliance guidelines with regards to billing preferred. 

• Must have basic knowledge of Knox-Keene, ERISA and California State laws that impact the billing process. 

• Must have basic knowledge of HIPAA and California State Confidentiality laws that impact the release of medical information 

Skills:  

• Superior customer service skills including oral, written, and listening skills in dealing with 

patients, physicians’ office staff, co-workers, and payers. 

• Has good organizational skills and flexibility. 

• Ability to make reasonable independent decisions in the absence of immediate direct supervision 

that stay within hospital and department guidelines. 

• Works as a team player assisting co-workers during periods of peak workloads and short 

staffing. 

• Must possess the ability to multi-task and reprioritize workload in order to meet deadlines. 

• 30 CWPM Data entry, ten-key skills required, basic filling skills, alphabetic, numeric and basic 

math skills required. 

• Ability to interpret contract and rate sheets for insurance.