Medical Billing Specialist - Exagen Inc.

Exagen is a patient-focused and discovery-driven life sciences company dedicated to transforming the care continuum for patients suffering from debilitating and chronic autoimmune diseases. Our goal is to enable rheumatologists to improve care for patients through the differential diagnosis, prognosis, and monitoring of complex autoimmune and autoimmune-related diseases, including lupus and rheumatoid arthritis.  By leveraging our proprietary Cell-Bound Complement Activation Products, or CB-CAPs, technology, we help get to the real cause of a patient’s symptoms and guide their journey to improved health.

Under the direction of the Billing Supervisor, the Medical Biller (Medical Billing Specialist) is responsible for managing claims from submission to adjudication.  The Medical Billing Specialist will also process appeals and grievances. They will conduct pertinent research in order to evaluate, respond to and close appeals while building case files for each grievance and ensure compliance with organizational and regulatory guidelines. Qualified candidates for the Medical Biller opening will have extensive knowledge of medical and third-party billing procedures, policies and concepts, a thorough understanding of Federal and State health programs, PPO, HMO, and Indemnity Plans.

Location note: The Medical Billing Specialist position is a hybrid role that requires on-site work out of our Carlsbad office and candidates must live within commuting distance.

• Review and reconcile accounts, identifying and resolving discrepancies
• Collaborate with internal medical billing teams to obtain necessary documentation and information for billing purposes
• Manages submission, intervention, and resolution of appeals, grievances, and/or complaints
• Conducts pertinent research, evaluates, responds and completes appeals and other inquiries accurately, timely and in accordance with all established regulatory guidelines.
• Prepares appeals summaries and correspondence and documents information for tracking/trending data
• Assists with processing incoming and outgoing correspondence
• Assists with the request and processing of patient medical records
• Assures timeliness and appropriateness of all Provider appeals according to federal and state guidelines
• Maintain accurate and organized billing records and documentation
• Other duties as assigned

• Minimum of 2 years’ medical billing experience, preferably in a laboratory billing environment
• Strong understanding of insurance billing, including Medicare, Medicaid and commercial insurance plans
• Able to identify payer and denial trends and provide solutions for process improvements and enhancements
• Excellent analytical skills
• Working knowledge of appropriate coding systems; CPT, ICD-10 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes
• Effective problem-solving skills in a fast paced and rapidly changing environment
• Excellent verbal and written communication skills
• Must be proficient in Microsoft Excel
• Quadax experience strongly desired

Pay range: $20 - $25/hr