Billing Liaison/Medical Billing Specialist

Medical Billing Specialist is responsible for coordinating and supporting the medical billing process for nursing facility and clinical patients and serving as a primary liaison between the organization, contracted billing company, nursing facilities, providers, and insurance payers. This position requires a strong understanding of healthcare billing, insurance requirements, diagnosis coding, nursing facility operations, and medical documentation.

Medical Billing Specialist will work closely with the organization's billing company to answer billing-related questions, resolve account and claim issues, obtain required information from nursing facilities, and ensure that claims are supported by accurate and appropriate documentation. The position will also assist with identifying billing discrepancies, addressing insurance-related issues, and facilitating timely claim submission and reimbursement.

Essential Duties and Responsibilities

• Serve as the primary internal contact for questions and issues related to medical billing and reimbursement.
• Work directly with the contracted billing company to answer questions, research billing issues, and provide necessary documentation or information to facilitate accurate claim submission and payment.
• Communicate with nursing facilities regarding patient information, diagnoses, medical documentation, insurance information, orders, and other items required for accurate billing.
• Review patient records and facility documentation to identify appropriate diagnosis information needed to support billing.
• Contact nursing facilities when diagnosis codes or supporting documentation are missing, incomplete, unclear, or inconsistent with the patient's medical record.
• Follow up with facilities and appropriate providers to obtain clarification or documentation necessary to support claims.
• Assist the billing company with resolving claim rejections, denials, billing discrepancies, and payer inquiries.
• Review insurance information and assist with determining appropriate primary and secondary payers.
• Maintain working knowledge of Medicare, Medicaid, Medicare Advantage, commercial insurance, managed care, and other applicable payer requirements.
• Assist with insurance eligibility, coverage, authorization, and benefit-related billing questions.
• Review Explanation of Benefits (EOBs), remittance information, claim status, and payer correspondence when necessary to assist with account resolution.
• Research and communicate with the billing company regarding unpaid, denied, or incorrectly processed claims.
• Assist in identifying accounts that require additional documentation, correction, resubmission, or payer follow-up.
• Monitor recurring billing issues and communicate trends or concerns to management.
• Coordinate with nursing facilities and providers to ensure required medical documentation is available to support billed services.
• Assist with medical billing audits by gathering records, reviewing billing information, and coordinating responses to requests for documentation.
• Ensure that billing-related information provided to the billing company is accurate, complete, and supported by the medical record.
• Identify potential discrepancies between medical documentation, diagnosis information, services provided, and billed services and escalate concerns appropriately.
• Maintain organized documentation of billing questions, facility communications, claim issues, and resolutions.
• Assist with correcting demographic, insurance, diagnosis, or other billing-related information when appropriate and authorized.
• Communicate professionally and effectively with nursing facility administrators, nurses, providers, billing personnel, insurance representatives, and internal staff.
• Maintain confidentiality of protected health information (PHI) and comply with HIPAA and organizational privacy and security requirements.
• Follow all applicable billing, documentation, compliance, and organizational policies and procedures.
• Perform other related duties as assigned.

Nursing Facility Communication

A key responsibility of this position is maintaining effective communication with nursing facilities to ensure that the billing company receives the information necessary to accurately process claims. Responsibilities include:

• Requesting missing or updated diagnosis information.
• Following up on diagnosis codes and supporting documentation.
• Clarifying patient demographics and insurance information.
• Obtaining required medical records, orders, physician documentation, or other supporting information.
• Communicating billing requirements and documentation needs to facility personnel.
• Following up timely on outstanding requests.
• Escalating unresolved documentation or billing issues to management when necessary.

Billing Company Liaison

The Medical Billing Specialist will work closely with the contracted billing company and will:

• Respond to billing questions and requests for additional information.
• Research discrepancies identified by the billing company.
• Provide documentation and information needed for claim submission and follow-up.
• Assist with identifying the reason for claim denials or rejections.
• Coordinate corrections and resubmissions when appropriate.
• Review unresolved billing issues and communicate necessary follow-up to the appropriate facility or department.
• Monitor outstanding issues to ensure they are addressed timely.
• Maintain clear communication between the organization, billing company, facilities, and providers.

Insurance and Reimbursement Responsibilities

• Maintain knowledge of Medicare, Medicaid, Medicare Advantage, managed care, commercial insurance, and other payer requirements applicable to nursing facility billing.
• Understand basic payer requirements for eligibility, coverage, authorizations, claims, diagnosis coding, and supporting documentation.
• Assist in researching insurance discrepancies and coverage issues.
• Identify potential payer-specific requirements that may affect claim processing or reimbursement.
• Assist with denial and rejection research and resolution.
• Recognize common billing errors that may result in delayed or denied reimbursement.

Compliance and Documentation

• Ensure billing information is supported by appropriate medical documentation.
• Do not knowingly provide or submit inaccurate, unsupported, or misleading billing information.
• Escalate potential billing, coding, documentation, or compliance concerns through the appropriate chain of command.
• Maintain accurate documentation of requests, communications, corrections, and resolutions.
• Follow applicable federal and state regulations, payer requirements, HIPAA requirements, and organizational policies.
• Assist with internal and external audits by gathering requested records and supporting documentation.
• Maintain strict confidentiality of patient and facility information.

Required Qualifications

• High school diploma or equivalent required.
• Minimum of 2 years of experience in medical billing, healthcare reimbursement, insurance verification, accounts receivable, or a related healthcare administrative role.
• Experience with nursing facility, long-term care, skilled nursing, or other post-acute healthcare billing strongly preferred.
• Working knowledge of Medicare, Medicaid, commercial insurance, and managed care.
• Familiarity with diagnosis codes and medical terminology.
• Strong understanding of medical billing processes and insurance claims.
• Excellent communication and follow-up skills.
• Strong attention to detail and ability to identify discrepancies.
• Ability to communicate effectively with nursing facility staff, providers, billing companies, and insurance representatives.
• Ability to manage multiple outstanding issues and meet established deadlines.
• Proficiency with electronic medical records, billing systems, Microsoft Office, and other applicable software.

Preferred Qualifications

• Experience working directly with a third-party medical billing company.
• Experience with nursing home or skilled nursing facility billing.
• Experience with Medicare and Medicaid billing.
• Experience with insurance denials, claim corrections, and appeals.
• Experience assisting with healthcare billing audits.
• Knowledge of ICD-10-CM diagnosis coding.
• Experience working with multiple nursing facilities or healthcare locations.
• Medical billing or coding certification preferred.

Key Competencies

• Medical billing and reimbursement knowledge
• Nursing facility billing experience
• Insurance knowledge
• Diagnosis-code familiarity
• Strong communication and interpersonal skills
• Problem-solving and critical-thinking skills
• Attention to detail
• Organization and follow-through
• Audit and compliance awareness
• Ability to work collaboratively with external billing partners
• Professional judgment and confidentiality

Pay: $16.00 - $20.00 per hour

Work Location: Hybrid remote in Kosciusko, MS 39090

Salary : $16 - $20