Billing Representative

About the role

The Billing/Revenue Cycle Liaison at Tiburcio Vasquez Health Center (TVHC) plays a crucial role in ensuring the timely and accurate processing of all third-party and self-pay billing. Reporting to Billing/Revenue Cycle leadership and supported by the Finance and Accounting Department, this position focuses on optimizing department performance in areas such as claims submission, adjudication, denial management, and follow-up on outstanding receivables.

Responsibilities

• Establishes, maintains, and updates patient accounts in accordance with TVHC policies and procedures.
• Works collaboratively with the Finance and Accounting Department to maximize reimbursement under all accepted insurance plans and self-pay arrangements.
• Performs timely follow-up on denied Remittance Advice/Explanation of Benefits (RA/EOB) for all insurance claims.
• Develops well-supported, patient-specific appeal documentation for payers when appeals are warranted, including medical necessity and prior authorization denials.
• Communicates regularly with management and operational staff to support smooth, efficient workflows across health center locations.
• Maintains current knowledge of billing practices, procedure codes, and payer requirements, and escalates compliance, red-flag activity, and fiscal concerns to appropriate leadership.
• Maintains the highest level of confidentiality to safeguard patient information and records.
• Supports the integrity of patient account records and related system documentation.
• Demonstrates the ability to meet or exceed TVHC’s Service Excellence Standards.
• Performs other duties as assigned.

Requirements

• A high school diploma or equivalent required.
• An associate degree in accounting or a related field strongly preferred.
• Completion of coding and billing coursework required.
• A minimum of two years of medical practice billing experience required; front-end medical practice experience and operational understanding preferred.
• Bilingual in English and Spanish required.
• Experience with Epic electronic billing and electronic health record systems in an FQHC environment.
• At least one year of accounts receivable experience, including billing, reconciliations, and collections.

Qualifications

• Excellent verbal and written communication skills.
• Strong analytical skills, including data analysis and review of billing procedures.
• Proficiency in Microsoft Office applications, particularly Excel, Word, and PowerPoint.
• Intermediate-level Microsoft Excel skills, ten-key by touch, strong attention to detail, and the ability to interpret contract language and calculate billing adjustments manually.
• Ability to produce reports and present information clearly and effectively.
• Excellent interpersonal and customer service skills.
• Ability to build effective working relationships with providers, front office teams, billing staff, and leadership.