Primary Care Biller

AMERICAN HEALTH SERVICES - 4.0

Santa Clarita, CA Job Details Full-time $20 - $23 an hour 1 hour ago Benefits Health insurance Paid time off Life insurance Qualifications Appeals Customer communication Microsoft Excel Medicare Overseeing healthcare denial management Medical coding experience in outpatient clinics High school diploma or GED Medicaid health insurance Case appeal in utilization management Substance abuse Medical denial root cause analysis (RCA) Centers for Medicare & Medicaid Services (CMS) billing regulations Medicaid regulations Medicaid Productivity software Root cause analysis Experience working with individuals with substance use disorders Insurance claims appeal handling Technical Proficiency Full Job Description Join our mission to provide substance use disorder services for the purpose of improving quality of life, instilling hope, and helping all people reach their full potential.

Motto:

Patients Come First Guiding Principle:

Our clinic provides an environment enabling physicians, counselors, patients, and all staff members to work as a team with mutual respect and dignity throughout the recovery process. We are a company of second chances and encourage everyone to apply and join our amazing team.

Job Description Title:

Primary Care/SUD Medical Biller Location :

Santa Clarita, CA - On Site Reports to:

Billing Supervisor Time/Status:

Regular/ Full Time (8:00 AM - 4:30 PM) Job Summary We are seeking a detail-oriented Primary Care/SUD Medical Biller to join our dedicated billing team. In this role, you will be responsible for managing the full-cycle billing process within a specialized behavioral health environment. The ideal candidate possesses a deep understanding of Drug Medi-Cal (DMC) reimbursement, California-specific billing codes (H0020, etc.), and the stringent confidentiality requirements of 42 CFR Part 2 . You will play a critical role in ensuring our clinic remains financially sustainable so that we can continue providing life-saving Medication-Assisted Treatment (MAT) to our community Essential Job Functions for Primary Care Billing Prepare and submit accurate electronic and paper claims to various insurance payers (Medicare, Medicaid, commercial insurance, managed care organizations) for outpatient methadone treatment, counseling, therapy, and other SUD services. Familiarity with specific coding and billing regulations for Substance Use Disorder Treatment (SUD) and medication-assisted treatment (MAT). Understanding of various insurance payer requirements (Medicare, Medicaid, commercial plans). Proficiency in medical billing software and EHR systems. Verify patient insurance eligibility, benefits, and coverage for methadone and other SUD treatment services prior to or upon admission. Obtain and track pre-authorizations and referrals as required by different payers, ensuring treatment is medically necessary and authorized for reimbursement. Communicate with patients regarding their insurance benefits, co-pays, deductibles, and financial responsibilities. Ensure all necessary documentation, including patient demographics, insurance information, medical necessity, and service details, is complete and accurate before submission. Utilize appropriate CPT, HCPCS, and ICD-10 codes, specifically those relevant to methadone administration (e.g., H0020, G-codes for bundled SUD services like

G2067, G2074, G2076, G2077

), individual and group therapy (e.g., 90832-90837, 90853), and assessments. Process and track claims from submission through payment. Maintain accurate and organized billing records, patient files, and financial information. Stay current with all federal, state, and local billing regulations, including

HIPAA, 42 CFR

Part 2 (Confidentiality of Substance Use Disorder Patient Records), Medicare, Medicaid, and commercial payer guidelines specific to OTPs and substance abuse treatment. Ensure all billing practices adhere to compliance standards to prevent fraud, waste, and abuse. Participate in internal and external audits as needed.

Proficiencies :

Interpersonal skills

Organizational Support Planning/Organizing Attendance/Punctuality Note:

This job description is intended to provide a general overview of the responsibilities and qualifications of the Outpatient Treatment Biller - Methadone Services. It is not exhaustive and may be subject to change based on the needs of the organization. Qualifications High school diploma (required) Minimum of 2-3 years of experience in medical billing, with a strong emphasis on outpatient behavioral health, mental health, or substance use disorder treatment. Specific experience with Methadone Treatment Programs (SUD) is highly preferred. Proven experience with denial management and appeals processes. Proficient in ICD-10, CPT, and HCPCS coding Knowledge of EHR systems, medical portals, Availity, and other relevant platforms Strong understanding of insurance guidelines, including Medicare and Medicaid Effective communication and interpersonal skills Proficiency in operating relevant computer software, including working knowledge of applications such as Microsoft Word, Excel, and EMR systems Substance Use Disorder (SUD) Understanding In-depth knowledge of medical billing and coding principles (CPT, HCPCS, ICD-10) Investigate and resolve denied, rejected, or underpaid claims promptly and efficiently. Identify root causes of denials (e.g., coding errors, lack of medical necessity, missing information, timely filing limits) and implement corrective actions. Prepare and submit appeals for denied claims, providing comprehensive supporting documentation and clinical rationale. Preferred Qualifications Specific experience with Methadone Treatment Programs (SUD) is highly preferred. Skills Proficiency in medical coding, billing, and collection processes is highly desirable. Strong understanding of medical terminology, including CPT, ICD-10, and ICD-9 coding systems. Ability to meet and maintain production and accuracy metrics

Benefits:

Health insurance Life insurance Paid time off (PTO)

Schedule:

8-hour shift (M-F) Office Setting/In person/

On-Site Pay:

$20.00 - $23.00 per hour Expected hours: 40.0 per week People with a criminal record are encouraged to apply

Work Location:

In person