Billing and Benefits Specialist

Title: Billing & Benefits Specialist

Department: Billing

Reports to: Director of Operations

Position: Full-Time, Mon-Fri (40 hours per week) – Hybrid / Fully Remote Options (Initial On-site 1-2 Week Training @ West Columbia) 

Company Description Consultants in Gastroenterology is a specialized medical practice focused on providing high-quality digestive health care. Our skilled and experienced gastroenterology professionals perform cancer screenings, colonoscopies, upper endoscopies (including EGD and ERCPs), and endoscopic ultrasounds (EUS). The team is dedicated to delivering accurate diagnostics and effective treatments in a supportive environment. Applicants will join a clinical setting committed to patient-centered care and excellence in gastrointestinal medicine.

Role Summary

The Billing & Benefits Specialist manages patient insurance verification, prior authorizations, medical claim submissions, payment posting, and insurance/patient benefit inquiries.  This role acts as a primary bridge between clinical services (such as office visits, colonoscopies, and endoscopies), insurance payers, and patients to maximize clean-claim reimbursement and ensure clear financial communication.

Key Responsibilities

Insurance Verification & Benefits

• Verify Coverage: Confirm active patient coverage, deductible status, and out-of-pocket maximums prior to scheduled office visits and specialized GI procedures (e.g., screening/diagnostic colonoscopies, EGDs).
• Prior Authorizations: Secure timely pre-authorizations and precertifications from commercial payers, Medicare Advantage, and Medicaid for office-based or ambulatory surgery center procedures.
• Benefit Explanations: Educate patients on their financial responsibility, co-pays, coinsurance, and deductibles in a transparent, compassionate manner.

Medical Billing & Revenue Cycle

• Charge Capture: Accurately enter and review charges using clinical documentation, ensuring proper linkage of CPT, ICD-10 (gastrointestinal diagnoses), and HCPCS codes.
• Claim Submission: Assemble and electronically submit clean claims to commercial insurers, Medicare, and Medicaid.
• Denials & Appeals: Investigate denied or rejected claims, compile necessary clinical notes/records, and submit formal peer-to-peer or written appeals.
• Payment Posting & Reconciliation: Post insurance and patient payments, reconcile ledgers against Explanations of Benefits (EOBs), and track accounts receivable (A/R).
• Patient Collections: Handle billing inquiries, resolve statement disputes, and set up reasonable payment plans.

Required Qualifications & Skills

• Education: High school diploma or GED required; associate degree, business/accounting coursework, or medical billing/coding certificate preferred.
• Experience: 2 years of medical billing, insurance verification, or revenue cycle experience, ideally within a private physician practice or specialty clinic. (Gastroenterology or surgical center background is a strong plus.)
• Technical Knowledge:
  • Proficiency in CPT, ICD-10, and HCPCS coding specific to GI procedures and office evaluations.
  • Familiarity with major commercial insurance portals, Medicare, and Medicaid guidelines.
  • Experience with Electronic Health Record (EHR) and Practice Management (PM) software.
• Compliance & Ethics: Strict adherence to HIPAA regulations and protected health information (PHI) standards.
• Soft Skills: Strong verbal and written communication skills for dealing with distressed or confused patients; high attention to detail and analytical problem-solving.