Job Title: Medical Billing Operations Specialist

Reports To: Operations Director

Employment Status: Full-Time

FLSA Status: Non-Exempt

Job Summary:

We are seeking a highly motivated and detail-oriented Medical Billing Office Operations Specialist to join our dynamic team. The ideal candidate will have a strong understanding of medical billing procedures, coding, insurance claims, and excellent customer service skills. This position will be responsible for ensuring accurate and efficient billing operations.

Duties/Responsibilities:

• Processes and submits insurance claims in a timely manner.

• Verifies insurance coverage and benefits, initiates pre-authorizations, and handles pre-certification of procedures.

• Utilizes ICD-10, CPT, and HCPCS coding systems accurately.

• Reviews medical records to ensure accurate coding and billing practices.

• Follows up on unpaid claims and manages denials by conducting investigations and filing appeals.

• Maintains strict confidentiality in accordance with HIPAA guidelines.

• Resolves patient inquiries and complaints related to billing.

• Documents billing procedures and maintains patient billing records.

• Generates and reviews financial and billing reports.

• Provides training and guidance to other billing staff as required.

• Stays updated with the latest insurance and healthcare regulations.

• All other duties as assigned.

Required Skills/Abilities:

• Excellent organizational and multi-tasking skills, with a keen eye for detail.

• Strong problem-solving abilities and analytical skills.

• Outstanding written and verbal communication skills.

• Proficiency in data entry and basic office software applications.

Education and Experience:

• High school diploma or equivalent required.

• Minimum of 2 years of experience in a medical billing or similar role.

• Proficiency in medical billing software and electronic health records (EHR).

• In-depth knowledge of insurance processes, including verification, pre-authorization, and claims appeal procedures.

Benefits

• Health Insurance

• Vision Insurance

• Dental Insurance

• 401(k) plan with matching contributions