Page 1 of 3 North Orange County Regional Health Foundation Job Description Title: Biller Salary Range: $22.00 - $25.00 Hour Reports to: Director of Finance Classification: Full-Time Non -Exempt Position Summary The Biller is responsible for the accurate and timely submission of claims in accordance with HRSA, Medi- Cal, Medicare, managed care, and other payer guidelines applicable to Federally Qualified Health Centers (FQHCs). This position ensures compliance with Prospective Payment System (PPS) billing requirements, scope of project guidelines, sliding fee discount program (SFDP) policies, and FQHC encounter- based reimbursement standards. The Biller plays a critical role in maintaining financial sustainability, regulatory compliance, and revenue integrity for services delivered at fixed clinic sites, mobile units, and homeless service locations. Key Duties and Responsibilities FQHC Claims Processing & Submission • Submit accurate electronic and paper claims for FQHC encounters in accordance with PPS methodology. • Ensure correct use of FQHC billing codes, including: o Revenue code 0521 o T1015 (FQHC encounter code) o Appropriate CPT/HCPCS codes • Verify encounters meet billable visit criteria under HRSA and Medi -Cal guidelines. • Confirm provider eligibility and credentialing status prior to claim submission. • Process claims for: o Primary care o Behavioral health o Optometry o Dental o ECM • Ensure claims reflect correct site -of-service where required. • Submit claims to Medi- Cal Fee -for-Service and Medi- Cal Managed Care Plans (e.g., CalOptima and other contracted plans). • Reconcile PPS wrap payments. Page 2 of 3 • Track capitated vs. encounter -based payments. • Identify underpayments and initiate corrections or appeals. • Monitor timely filing requirements. Medicare & Commercial Billing • Process Medicare FQHC claims under appropriate billing methodology. • Ensure compliance with Medicare FQHC payment rules. • Submit secondary claims when applicable. • Coordinate benefits accurately. Denials Management & A/R Follow -Up • Review and resolve claim denials in a timely manner. • Identify root causes of denials and recommend corrective actions. • Submit corrected claims and formal appeals as needed. • Maintain denial tracking logs and productivity benchmarks. • Work A/R aging reports and prioritize high -dollar or time -sensitive claims. Documentation Review & Revenue Integrity • Review superbills and EHR documentation for completeness and accuracy. • Communicate coding discrepancies to providers and clinical staff. • Participate in internal chart audits as directed. • Support Quality Improvement (QI) initiatives related to documentation accuracy and revenue capture. Team -Based Care & FQHC Alignment • Collaborate with front office, medical assistants, providers, and ECM staff to ensure accurate encounter capture. • Participate in team meetings related to workflow improvement. • Maintain confidentiality and HIPAA compliance at all times. Qualifications Education • High school diploma or equivalent required. • Associate degree in Medical Billing, Health Information Management, or related field preferred. Experience Page 3 of 3 • Minimum 2 -3 years of medical billing experience required. • Minimum 1 year of FQHC billing experience strongly preferred. • Experience with: o Medi -Cal PPS billing o T1015 encounter billing o Managed care wrap payments o Medicare FQHC billing o Safety -net population billing (preferred) Knowledge & Skills • Strong understanding of: o HRSA FQHC billing guidelines o PPS methodology o CPT, ICD -10, HCPCS coding o Revenue cycle management • Experience with EHR and practice management systems. • Strong analytical and denial resolution skills. • Ability to work in fast -paced, compliance -driven environment. Core Competencies • Accuracy and attention to detail • Compliance -driven mindset • Accountability • Strong communication skills PHYSICAL REQUIREMENTS: The physical demand described here are representative of those that must be met by an employee to successfully perform the essential functions this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. • TB Clearance • Must have reliable transportation with minimum insurance/liability coverage • Ability to travel locally to program sites and partner organizations as needed. • Sits, stands, and walks intermittently throughout the day. • Regularly required to talk and listen to others in person and over the phone. • Occasionally required to climb, stoop, bend, k neel, crouch, and reach above shoulders. Employee Signature: ____ Employee Name: _ Date: ___