Medical Biller - Workers Compensation Specialist

The ideal candidate will be responsible for managing the complete billing cycle, ensuring accurate claim submission, timely reimbursement, and compliance with applicable state and federal regulations. Our state-of-the-art centers focus on the episodic treatment of acute illnesses and injuries, workers' compensation, and occupational medicine.

Benefits:

• Health insurance
• Training & development
• Vision insurance
• 401(k) matching
• Dental insurance
• Paid time off
• Savings bank

Company Overview
American Family Care (AFC) is one of the largest primary and urgent care companies in the U.S. providing services seven days a week on a walk-in basis. Our state-of-the-art centers focus on the episodic treatment of acute illnesses and injuries, workers' compensation, and occupational medicine. 
AFC is the parent company of AFC Franchising, LLC (AFCF). This position works directly with a franchised business location. The specific job duties and benefits can vary between franchises. 
 
Job Summary
We are seeking an experienced and detail-oriented Medical Biller with a strong background in Workers’ Compensation claims processing and billing. The ideal candidate will be responsible for managing the complete billing cycle, ensuring accurate claim submission, timely reimbursement, and compliance with applicable state and federal regulations. 


Responsibilities 

• Prepare and submit accurate California workers’ compensation medical bills and claims.
• Verify claim information, insurance coverage, adjuster information, and billing requirements.
• Monitor claims from submission through payment.
• Follow up on unpaid, delayed, rejected, and denied claims.
• Research and resolve billing discrepancies.
• Review EOBs, payment reports, denials, and adjustments.
• Identify underpayments and take appropriate corrective action.
• Communicate professionally with insurance carriers, claims adjusters, bill review companies, attorneys, and other representatives.
• Maintain detailed documentation of all claim follow-up.
• Manage aging accounts and prioritize high-value and problem accounts.
• Assist with appeals, reconsideration, and other billing-related correspondence.
• Post payments and adjustments accurately.
• Reconcile accounts and identify outstanding balances.
• Work closely with clinical and administrative staff to resolve issues affecting reimbursement.
• Maintain accurate and organized billing records.
• Meet established productivity, accuracy, A/R, and collection goals.
• Perform other duties as assigned 

Performance Expectations and Billing Goals
This position will be measured by specific monthly, quarterly, and annual performance goals.
Meet monthly collection and A/R performance targets established by management.
Provide a monthly A/R and collection report to management.
Maintain appropriate levels of productivity while maintaining billing accuracy.

1. Claims denied or rejected
2. Denial resolution
3. Underpayment identification
4. Outstanding claims requiring follow-up
5. Collection performance compared with established goals

Qualifications

• Minimum of 2 years of medical billing experience.
• Minimum of 1 year of Workers’ Compensation billing experience.
• Knowledge of medical terminology, CPT, ICD-10, and HCPCS coding.
• Experience with claim denial management and appeals.
• Proficiency with electronic medical records (EMR) and billing software.
• Strong knowledge of medical terminology, medical records management, and healthcare documentation standards.
• Strong organizational skills and attention to detail.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities and meet deadlines.

Preferred

• Experience in outpatient rehabilitation, occupational therapy, physical therapy, or healthcare clinic settings.
• Familiarity with California Workers’ Compensation billing regulations and OMFS fee schedules.
• Experience working with medical providers, therapy clinics, or rehabilitation.
• Certification such as CPC, CPB, or equivalent.
• Bilingual in Spanish preferred, but not required