Billing and Credentialing Specialist
$23 - $28/hr
The Billing & Credentialing Specialist is responsible for managing the full revenue cycle for ... Review, analyze, and resolve claim denials related to medical necessity, coding, benefit coverage ...
$23 - $28/hr
The Billing & Credentialing Specialist is responsible for managing the full revenue cycle for ... Review, analyze, and resolve claim denials related to medical necessity, coding, benefit coverage ...
$23 - $28/hr
The Billing & Credentialing Specialist is responsible for managing the full revenue cycle for ... Review, analyze, and resolve claim denials related to medical necessity, coding, benefit coverage ...
Irvine, CA · On-site
$23 - $28/hr
The Billing & Credentialing Specialist is responsible for managing the full revenue cycle for ... Review, analyze, and resolve claim denials related to medical necessity, coding, benefit coverage ...
Irvine, CA · On-site
$23 - $28/hr
The Billing & Credentialing Specialist is responsible for managing the full revenue cycle for ... Review, analyze, and resolve claim denials related to medical necessity, coding, benefit coverage ...
Rancho Santa Margarita, CA · On-site
$19 - $25/hr
We require experience in all aspects of patient care coordination, including busy phones, check-in/check-out, insurance verification, registration, some medical billing codes; managed care ...
Quick apply
Rancho Santa Margarita, CA · On-site
$19 - $25/hr
We require experience in all aspects of patient care coordination, including busy phones, check-in/check-out, insurance verification, registration, some medical billing codes; managed care ...
Orange, CA · On-site
$70K - $85K/yr
Review medical record information on both a retroactive and prospective basis to identify, assess ... Interacts with physicians regarding coding, billing, documentation policies, procedures, and ...
Orange, CA · On-site
$70K - $85K/yr
Review medical record information on both a retroactive and prospective basis to identify, assess ... Interacts with physicians regarding coding, billing, documentation policies, procedures, and ...
Upland, CA · On-site
$18 - $24/hr
Minimum 2 years experience in Billing * Excellent communication skills (both verbal and written ... Knowledge of ICD-10 and CPT Codes * Proficient with Excell * Responsible and Reliable
Quick apply
Upland, CA · On-site
$18 - $24/hr
Minimum 2 years experience in Billing * Excellent communication skills (both verbal and written ... Knowledge of ICD-10 and CPT Codes * Proficient with Excell * Responsible and Reliable
Upland, CA · On-site
$18 - $24/hr
Minimum 2 years experience in Billing * Excellent communication skills (both verbal and written ... Knowledge of ICD-10 and CPT Codes * Proficient with Excell * Responsible and Reliable
Quick apply
Upland, CA · On-site
$18 - $24/hr
Minimum 2 years experience in Billing * Excellent communication skills (both verbal and written ... Knowledge of ICD-10 and CPT Codes * Proficient with Excell * Responsible and Reliable
Ontario, CA · On-site
$26.04 - $32.37/hr
The Outpatient Coder Auditor Trainee finalizes the ... coding and abstracting of the medical record upon ensuring the assignment of International ...
Ontario, CA · On-site
$26.04 - $32.37/hr
The Outpatient Coder Auditor Trainee finalizes the ... coding and abstracting of the medical record upon ensuring the assignment of International ...
The specialist reviews medical records to identify all appropriate coding, generates invoices for insurance and patient billing, and manages insurance claims and collections. Collaboration with ...
The specialist reviews medical records to identify all appropriate coding, generates invoices for insurance and patient billing, and manages insurance claims and collections. Collaboration with ...
Orange, CA · On-site
$70K - $85K/yr
... training those without previous provider education experience! This position requires travel to ... Review medical record information on both a retroactive and prospective basis to identify, assess ...
Orange, CA · On-site
$70K - $85K/yr
... training those without previous provider education experience! This position requires travel to ... Review medical record information on both a retroactive and prospective basis to identify, assess ...
Ontario, CA · On-site
$26.04 - $32.37/hr
The Outpatient Coder Auditor Trainee finalizes the ... coding and abstracting of the medical record upon ensuring the assignment of International ...
New
Ontario, CA · On-site
$26.04 - $32.37/hr
The Outpatient Coder Auditor Trainee finalizes the ... coding and abstracting of the medical record upon ensuring the assignment of International ...
New
Ontario, CA · On-site
$26.04 - $32.37/hr
The Outpatient Coder Auditor Trainee finalizes the ... coding and abstracting of the medical record upon ensuring the assignment of International ...
New
Ontario, CA · On-site
$26.04 - $32.37/hr
The Outpatient Coder Auditor Trainee finalizes the ... coding and abstracting of the medical record upon ensuring the assignment of International ...
New
Ontario, CA · On-site
$26.04 - $32.37/hr
The Outpatient Coder Auditor Trainee finalizes the ... coding and abstracting of the medical record upon ensuring the assignment of International ...
Ontario, CA · On-site
$26.04 - $32.37/hr
The Outpatient Coder Auditor Trainee finalizes the ... coding and abstracting of the medical record upon ensuring the assignment of International ...
Orange, CA · On-site
$70K - $85K/yr
Review medical record information on both a retroactive and prospective basis to identify, assess ... Interacts with physicians regarding coding, billing, documentation policies, procedures, and ...
New
Orange, CA · On-site
$70K - $85K/yr
Review medical record information on both a retroactive and prospective basis to identify, assess ... Interacts with physicians regarding coding, billing, documentation policies, procedures, and ...
New
Orange, CA · On-site
$70K - $85K/yr
Review medical record information on both a retroactive and prospective basis to identify, assess ... Interacts with physicians regarding coding, billing, documentation policies, procedures, and ...
New
Orange, CA · On-site
$70K - $85K/yr
Review medical record information on both a retroactive and prospective basis to identify, assess ... Interacts with physicians regarding coding, billing, documentation policies, procedures, and ...
New
Brea, CA · On-site
$20 - $27.50/hr
... billing and reports based on health plan, payor, or contract requirements. This also involves ... Attend Information Systems security training, when offered, and report information system security ...
Brea, CA · On-site
$20 - $27.50/hr
... billing and reports based on health plan, payor, or contract requirements. This also involves ... Attend Information Systems security training, when offered, and report information system security ...
Riverside, CA · On-site
$49K - $65K/yr
... coding training to Certified Medical Record Coder - Outpatient as needed. Minimum Qualifications Recruiting Guidelines OPTION I Experience: Four years as a Certified Medical Records Coder ...
Riverside, CA · On-site
$49K - $65K/yr
... coding training to Certified Medical Record Coder - Outpatient as needed. Minimum Qualifications Recruiting Guidelines OPTION I Experience: Four years as a Certified Medical Records Coder ...
Brea, CA · On-site
$20 - $27.50/hr
... billing and reports based on health plan, payor, or contract requirements. This also involves ... Attend Information Systems security training, when offered, and report information system security ...
Brea, CA · On-site
$20 - $27.50/hr
... billing and reports based on health plan, payor, or contract requirements. This also involves ... Attend Information Systems security training, when offered, and report information system security ...
Riverside, CA · On-site
$70K - $104K/yr
... coding training to Certified Medical Record Coder - Outpatient as needed. MINIMUM QUALIFICATIONS Recruiting Guidelines OPTION I Experience: Four years as a Certified Medical Records Coder ...
Riverside, CA · On-site
$70K - $104K/yr
... coding training to Certified Medical Record Coder - Outpatient as needed. MINIMUM QUALIFICATIONS Recruiting Guidelines OPTION I Experience: Four years as a Certified Medical Records Coder ...
Riverside, CA · On-site
$70K - $104K/yr
... coding training to Certified Medical Record Coder - Outpatient as needed. MINIMUM QUALIFICATIONS Recruiting Guidelines OPTION I Experience: Four years as a Certified Medical Records Coder ...
Riverside, CA · On-site
$70K - $104K/yr
... coding training to Certified Medical Record Coder - Outpatient as needed. MINIMUM QUALIFICATIONS Recruiting Guidelines OPTION I Experience: Four years as a Certified Medical Records Coder ...
... Medical billing code knowledge is required * 6. EMR system usage is highly preferred Under the supervision of the Quality Improvement Team Leader, the Patient Access Coordinator is responsible for ...
Quick apply
... Medical billing code knowledge is required * 6. EMR system usage is highly preferred Under the supervision of the Quality Improvement Team Leader, the Patient Access Coordinator is responsible for ...
$13.54 - $14.91
2% of jobs
$14.91 - $16.28
4% of jobs
$16.28 - $17.65
12% of jobs
$18.42 is the 25th percentile. Wages below this are outliers.
$17.65 - $19.01
13% of jobs
$19.01 - $20.38
17% of jobs
The median wage is $20.63 / hr.
$20.38 - $21.75
15% of jobs
$22.95 is the 75th percentile. Wages above this are outliers.
$21.75 - $23.12
15% of jobs
$23.12 - $24.49
9% of jobs
$24.49 - $25.85
7% of jobs
$25.85 - $27.22
3% of jobs
$27.22 - $28.59
3% of jobs
$13
$21
$28
| Aspect | Trainee Medical Billing Coding Training | Medical Billing Specialist |
|---|---|---|
| Credentials | Often no formal certification required initially; training programs prepare for certifications | Typically holds certifications like CPC or CBCS |
| Work Environment | Classroom or online training; internship or supervised practice | Healthcare offices, hospitals, or billing companies |
| Job Role | Learning billing and coding procedures; entry-level tasks | Processing claims, coding diagnoses and procedures, managing billing |
| Industry Usage | Training phase before employment or certification | Full-time professional role in medical billing |
In summary, Trainee Medical Billing Coding Training is an educational phase preparing individuals for a career in medical billing, while a Medical Billing Specialist is a trained professional actively performing billing and coding tasks in healthcare settings.

$23 - $28/hr
Full-time
Re-posted 14 days ago
Profile Summary:
The Billing & Credentialing Specialist is responsible for managing the full revenue cycle for infusion services, including benefits investigation, verification, accurate claim submission, denial resolution, and AR follow-up. This role handles complex buy-and-bill infusion billing, including J-codes, S-codes, NDC crosswalks, biologics, and time-based infusion services.Â
Additionally, the specialist manages provider credentialing and enrollment with Medicare, Medi-Cal, and commercial payers, ensuring compliance and timely activation. The position supports patients, providers, and internal departments to optimize reimbursement and maintain continuity of care.
Key Accountabilities:Â
Medical Benefits Billing & Revenue Cycle ManagementÂ
Verify medical benefits for infusion services, including specialty biologics, IVIG, and injectable therapies.Â
Complete detailed benefit investigation (BI) for medical benefits, deductible, OOP, copay, and coverage limitations.Â
Process, correct, and submit claims using CMS-1500 and UB-04 forms for facility and professional billing.Â
Apply proper coding for infusion services including:Â
J-codes / S-codesÂ
NDC conversions & crosswalksÂ
Infusion CPT codes (96365-96379, 96401-96417)Â
Modifier accuracy (JW, JG, 59, 25, etc.)Â
Manage buy-and-bill billing including ASP pricing, wastage documentation, and payer-specific requirements.Â
Monitor claim status and process secondary or tertiary claims as required.Â
Perform comprehensive AR collections, including tracking outstanding balances and resolving unpaid or underpaid claims.Â
Research and resolve claim errors, coding issues, and payer-specific infusion policies.Â
Manage prior authorization follow-up with the PA team and ensure claims are billed compliant with authorization terms.Â
Communicate with payers to resolve rejections, eligibility discrepancies, and coverage issues.Â
Denials, Appeals & ReconsiderationsÂ
Review, analyze, and resolve claim denials related to medical necessity, coding, benefit coverage, or documentation.Â
Prepare and submit appeal packets including clinical justifications, medical records, infusion notes, and prior authorization details.Â
Draft high-quality appeal letters based on denial category and payer requirements.Â
Track appeal turnaround times and follow up with payers until resolution.Â
Coordinate with prescribers to obtain clinical notes, labs, and additional documents required for approvals or appeals.Â
Provider Credentialing & Payer EnrollmentsÂ
Complete credentialing and enrollment for providers with Medicare, Medi-Cal, and commercial insurance plans.Â
Maintain and update CAQH, NPPES, PECOS, and payer portal information.Â
Initiate and manage re-credentialing processes and track expiring documents.Â
Maintain an organized, compliant credentialing database.Â
Communicate with insurers and internal teams to ensure timely activation of provider billing privileges.
Division team/specific Accountabilities:Â Â
Communicate with patients to gather information required for benefits verification, billing setup, financial counseling, and to ensure accurate processing of infusion orders and authorizations. Build clear, supportive communication that promotes trust and patient loyalty.Â
Investigate and verify medical benefits for infusion and specialty biologic services, including deductible, co-pay, out-of-pocket costs, prior authorization requirements, site-of-care restrictions, step therapy, and medical policy guidelines.Â
Coordinate with manufacturer financial assistance programs, copay foundations, and internal support teams to help eligible patients obtain financial support, copay cards, or patient-assistance funding when appropriate.Â
Work closely with the Prior Authorization team by providing all required clinical and documentation updates, ensuring timely submission, tracking authorization progress, and maintaining consistent communication with the patient and provider.Â
Facilitate denial and appeal processes by requesting denial documentation, gathering clinical records, and preparing appeal packets. Compose appeal letters based on denial reason, medical necessity, and the patient's clinical condition.Â
Conduct regular status checks with insurance companies on pending authorizations, appeals, and claim adjudications. Obtain approval information, document outcomes, and update copay or financial assistance statuses when required.Â
Identify, track, and escalate service-delaying issues related to prior authorizations, benefit determinations, clinical documentation, or financial assistance gaps to ensure uninterrupted patient therapy and timely infusion scheduling.Â
Build and maintain effective working relationships with prescriber offices, referral partners, and clinical staff treating assigned disease states. Provide ongoing updates regarding case status, authorizations, and payer requirements.Â
Complete all required assessments or checklists mandated by manufacturer programs, payer requirements, or internal workflow processes to ensure compliance with program standards.Â
Review and respond to notifications of patients who require financial assistance, providing them with available program options, community resources, and support to help minimize out-of-pocket burden.Â
Assist patients with submitting financial assistance applications, including obtaining consent forms, uploading documentation, completing electronic applications, and following up with financial assistance programs to prevent therapy interruptions.Â
Maintain timely updates on pending or unfilled infusion orders, keeping prescription and authorization statuses current in the system at least every 48 hours or per department protocol.Â
Ensure that all activities comply with organizational standards, payer guidelines, manufacturer program requirements, and HIPAA. Deliver service in a manner that meets the highest standards of quality, accuracy, and patient care.Â
Experience:
A minimum of 2 years of prior experience in a medical records department or like setting preferred. Â
Prior experience with an Infusion clinic. (preferred)Â
Dealing with third party billers. (preferred)
Behavioral Competencies:
Excellent verbal and written communication skills.  Â
Excellent interpersonal, negotiation, and conflict resolution skills. Â
Excellent organizational skills and attention to detail. Â
Strong analytical and problem-solving skills. Â
Ability to prioritize tasks and to delegate them when appropriate. Â
Ability to act with integrity, professionalism, and confidentiality.