Medical Office Specialist - Authorizations & Billing

Medical Office Specialist - Authorizations & Billing Evolve Restorative Center - 5.0 Santa Rosa, CA Job Details Full-time $25 - $30 an hour 19 hours ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance 401(k) matching Retirement plan Qualifications Appeals Customer communication Overseeing health insurance pre-certification Insurance verification EHR systems Medical coding High school diploma or GED Case appeal in utilization management Medical records Electronic health record (EHR) management for billing and coding Microsoft Teams Medical claims submission Productivity software Epic Insurance claims appeal handling Medical terminology Office experience Full Job Description

MEDICAL AUTHORIZATION/BILLING SPECIALIST SUMMARY

The Authorization and Billing Specialist is responsible for coordinating insurance authorizations, managing claims submission, resolving billing issues, and supporting patients with billing-related inquiries. This role ensures timely and accurate processing of authorizations and insurance claims, maintains compliance with payer guidelines, and works cross-functionally to resolve billing and reimbursement issues. Proficiency in EPIC is required. The ideal candidate is detail-oriented, organized, and customer-focused, with strong knowledge of healthcare billing workflows and insurance processes.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Authorizations & Referrals Process new patient pre-intake authorizations and verify insurance coverage for procedures, tests, and office visits. Track and follow up on pending authorizations, including referrals, imaging, and diagnostic approvals. Maintain accurate documentation of all authorization and referral activity in EPIC. Manage incoming and outgoing mail and faxes related to authorizations. Coordinate with providers and insurance companies to resolve issues or delays. Handle appeals and resubmissions for denied authorizations with appropriate documentation. Manage workers' compensation claims and authorization processes. Billing & Claims Management Submit accurate, timely claims using EPIC and ensure compliance with coding and billing regulations. Follow up on outstanding claims to ensure payment is received within payer timelines. Identify and correct billing errors, denials, or rejected claims and resubmit as needed. Ensure all charges are authorized and accurately linked to supporting documentation. Monitor claim turnaround times and escalate issues as needed. Collaborate with Accounts Payable and Receivable to support accurate posting, reconciliation, and resolution of payment discrepancies. Verify patient demographics and insurance data to support clean claims and minimize rework. Coding & Documentation Support Review clinical documentation to ensure accuracy of CPT, ICD-10, and HCPCS codes before submission. Upload and manage supporting documents needed for claim adjudication or appeals. Coordinate with providers or coders to correct discrepancies or improve documentation. Patient Communication & Support Serve as a resource for patients with billing, insurance, or authorization-related questions. Clearly explain financial responsibility including copays, deductibles, and coinsurance. Assist with resolving billing disputes and ensure timely follow-up. Fax, mail, or upload billing statements and insurance documents as needed for patients or third parties. Departmental & Operational Support Participate in internal quality assurance by identifying recurring issues or patterns in billing or authorization workflows. Provide feedback to management on process inefficiencies and potential improvements to SOPs and departmental workflows. Assist with monitoring call and message activity related to billing/authorization and ensure timely patient response. Maintain HIPAA compliance and ensure confidentiality of all patient and financial records. Stay informed about payer policies, health plan requirements, and applicable state/federal billing regulations. Contribute to the overall effectiveness of the billing and authorizations team through cross-functional collaboration and support.

QUALIFICATIONS

Required:

High school diploma or equivalent. 3-5 years of experience in medical billing and insurance authorizations. Strong working knowledge of EPIC (billing and clinical workflows). Experience with insurance claims submission, denials, appeals, and follow-up. Proficient in Microsoft Office Suite, OneDrive, and Teams. Excellent attention to detail, written/verbal communication, and organizational skills. Strong knowledge of

CPT, ICD-10, HCPCS

coding, and claim life cycle. Ability to prioritize tasks and work independently in a fast-paced environment. Reliable transportation.

Preferred:

Bilingual (Spanish/English). Familiarity with workers' compensation and multi-payer insurance systems. Experience working in a surgical or specialty medical setting.

Job Type:

Full-time Pay:

$25.00 - $30.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Paid time off Retirement plan Vision insurance

Work Location:

In person