Medical Billing Specialist

Yosemite Pathology (YP) is a private independent pathologist owned and operated surgical pathology and cytology laboratory based in Modesto, CA. YP provides comprehensive state of the art, reliable, and accurate diagnostic services to its physicians and major area hospitals in the Alameda, Amador, Calaveras, Contra Costa, Kern, Mariposa, Merced, San Joaquin, Solano, Stanislaus and Tuolumne counties.

YP offers a full spectrum of tissue pathology, cytology and histology services, including examination of gynecologic specimens, body fluids and fine needle aspiration specimens. We also offer an extensive array of special stains and immunohistochemistry to assist in the management of oncologic and non-oncologic diseases. The laboratory is supported by highly qualified Histotechnologist, Cytotechnologist, Technicians and office staff who offer excellent service.

Summary/Objective

The Billing Specialist plays a critical role in integrating billing and revenue cycle best practices for all payor groups. This position focuses on front-end claims management, collaborating with front-end teams and other members of the revenue cycle team to ensure the accurate and timely submission of claims. The specialist will be responsible for gathering requisitions, entering patient data, verifying insurance information, resolving billing discrepancies, and ensuring proper billing, with the ultimate goal of optimizing initial claims accuracy and revenue flow. This role requires a strong understanding of medical billing, coding practices, and healthcare regulations, along with a high attention to detail and excellent communication skills.

Shift: Monday - Friday 7:30am - 4pm (One hour flexible on start time)

Essential Functions

• Answers and directs phone calls
• Responds to messages in a timely manner
• Maintains requisitions and obtains missing documents
• Links requisitions to appropriate accessions
• Data entry of patient demographics and insurance information
• Corresponds with hospitals and doctor's offices to obtain missing information
• Reviews and resolves daily Error Processing worklists (bad addresses, no authorization, eligibility undetermined, etc.) in a timely manner
• Pro-actively identifies clearinghouse rejection trends
• Forwards qualifying accounts to third party collections agency as needed
• Achieves or exceeds daily KPIs
• Always adheres to HIPAA compliance, including when accessing client portals
• Reviews various reports, including data entry, error processing, and clearing house rejections as instructed
• Floats between front-end tasks to ensure a seamless, efficient, and accurate flow of the revenue cycle
• Supports positive change in the department
• Supports the team to improve collections, communicate issues, and implement ideas
• Supports internal and external audits by providing necessary documentation and addressing any audit findings
• All other duties as assigned

Job Requirements and Skills

• High school diploma or equivalent required; Associate's degree preferred.
• Experience in medical billing, patient registration, healthcare data entry, or revenue cycle operations required.
• Familiarity with laboratory or pathology billing workflows preferred.
• Experience using healthcare billing or revenue cycle systems, preferably NovoPath and/or XiFin.
• Knowledge of insurance types, billing terminology, and payer requirements, including commercial insurance, Medicare, and Medicaid.
• Basic understanding of HIPAA regulations and patient confidentiality standards.
• Strong attention to detail with a focus on data accuracy and integrity.
• Ability to identify, research, and resolve billing and data discrepancies efficiently.
• Experience working in high-volume error queues, billing correction workflows, or unbillable account resolution preferred.
• Strong analytical, organizational, and problem-solving skills.
• Effective written and verbal communication skills with the ability to collaborate across departments.
• Ability to manage multiple priorities and meet deadlines in a fast-paced laboratory environment.

Compensation and Benefits

• The compensation is $47,840 - $56,160 annually paid semi-monthly on an eight (8) hour per day, forty (40) hour per week. Final salary offer subject to multiple factors including candidate experience and expertise, geographic location of the role, and current market data.
• 401(k) includes an employer match up to 4%
• Robust health plans including dental, vision, life, and mental health support.
• Offer generous annual vacation and sick time
• 10 paid holidays
• Annual scrub allowance for Lab roles

Work Environment

This position operates in an office environment and involves frequent time spent at a desk using a computer. This position works individually, as well as with peers and supervisors frequently.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand, walk, use hands to finger, handle or feel, and reach with hands and arms. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive list of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

All offers of employment at Yosemite Pathology are contingent upon clear results of a thorough background check. Background checks will be conducted on all final candidates.