Medical Billing Specialist - Stop Hold

Medical Billing Specialist

Position Summary

The Billing Specialist plays a key role in ensuring accurate claim processing, timely reimbursement, and exceptional customer service. This position is responsible for following up on unpaid claims, filing appeals, maintaining accurate patient and insurance data, and supporting the billing team as needed. The ideal candidate is detail‑oriented, organized, and comfortable working in a fast‑paced medical billing environment.

Key Responsibilities

• Accounts Receivable Follow‑Up— Monitor aging reports, follow up on unpaid claims, and file appeals when necessary to maximize reimbursement.
• Claims Processing— Perform adjudication, E‑Claims pre‑edits, claim adjustments, voids, and corrections.
• Insurance Verification— Verify insurance coverage, obtain prior authorizations, and submit pre‑notifications.
• Data Entry & Payment Posting— Enter patient demographics, guarantor information, insurance details, and post procedures and payments.
• Documentation Management— Obtain valid CMNs/DWOs and confirm sales orders.
• Customer & Provider Support— Resolve billing inquiries from patients, referral sources, and providers.
• Product & Pricing Setup— Research new products, determine HCPC codes, set up items in Brightree, and maintain payer pricing schedules.
• Team Collaboration— Serve as a backup for other billing staff and participate in process improvement initiatives.
• Maintain regular attendance and perform other duties as assigned.

Qualifications

• High school diploma or equivalent preferred.
• Experience with medical billing, medical terminology, or coding preferred.
• Working knowledge of Brightree software is a plus (training available).
• Strong understanding of accounting concepts and medical billing regulations.
• Ability to analyze and resolve problems independently.
• Excellent written and verbal communication skills with strong phone etiquette.
• High attention to detail and proven ability to multitask.
• Ability to maintain confidentiality and exercise sound judgment.
• Strong computer skills and willingness to learn new systems.
• Must be able to read, write, and speak English fluently.
• Highly motivated team player with strong customer service skills.
• Willingness to complete DME training, attend vendor in‑services, and stay current on Medicare and insurance guidelines.

Work Environment

• Office/Retail setting with regular interaction with staff, patients, and referral sources.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.