Billing Specialist - PART TIME

Billing Specialist – LMC

Reports to: LMC Office Manager

SUMMARY:

The Medical Biller is responsible for ensuring accurate, timely, and compliant billing and follow-up for services provided by the Federally Qualified Health Center (FQHC). This position supports the organization’s financial sustainability by submitting clean claims, resolving denials, and maintaining compliance with HRSA, CMS, Medicaid, Medicare, and commercial payer requirements. The Medical Biller uses strong analytical skills, attention to detail, and knowledge of FQHC billing methodologies, including PPS and encounter-based reimbursement, to manage complex billing processes across multiple payer types.

The Billing Specialist routinely communicates with clinic staff, insurance companies, and patients to obtain, clarify, and resolve claim and payment information. This role is responsible for identifying process gaps within the billing and charge capture workflow and developing functions, workflows, and system-based solutions to mitigate issues at the source. The Medical Biller is accountable for billing-related system setup, including charge configuration and billing rules, and for documenting standardized billing processes for staff to implement and maintain across the organization.

The position requires the ability to work independently, prioritize competing deadlines, and collaborate effectively with clinical, front desk, and administrative teams. Proficiency with electronic health record (EHR) and practice management systems is essential, as is maintaining strict confidentiality of patient information and adhering to ethical billing practices. A working knowledge of CPT, ICD-10-CM, HCPCS coding concepts, insurance guidelines, and payer regulations is required.

Work is primarily performed in an office environment and involves extended periods of sitting and computer use. The role may require occasional overtime during peak billing cycles, audits, or month-end close. Consistent focus, accuracy, and productivity are critical to success in this position.

MINIMUM QUALIFICATIONS:

• High school diploma or equivalent required
• Minimum 2 years of medical billing experience, preferably in an FQHC or community health setting
• Working knowledge of Medicaid, Medicare, and managed care billing
• Strong understanding of CPT, ICD-10-CM, and HCPCS coding concepts
• Experience using electronic health record (EHR) and practice management systems
• Proficiency with Microsoft Office, especially Excel

ESSENTIAL DUTIES:

• Prepare, review, and submit accurate electronic and paper claims for medical, dental, behavioral health, and allied health services.
• Ensure proper use of FQHC-specific billing methodologies, including Prospective Payment System (PPS) and encounter-based billing.
• Verify correct CPT, HCPCS, ICD-10-CM codes and modifiers in compliance with payer and CMS requirements.
• Submit claims timely and in accordance with payer filing limits; monitor claim status and perform follow-up on unpaid or denied claims.
• Research, correct, and resubmit denied claims and actively manage accounts receivable to ensure timely reimbursement.
• Post payments and contractual adjustments accurately, as assigned.
• Verify insurance eligibility and benefits and ensure appropriate coordination of benefits.
• Maintain working knowledge of Medicaid managed care plans and state-specific billing rules.
• Manage billing collections activities and monitor outstanding patient balances, accounts receivable, and bad debt to ensure performance remains within established thresholds.
• Apply Sliding Fee Discount Program (SFDP) policies accurately and in compliance with HRSA requirements.
• Support data integrity and accuracy for Uniform Data System (UDS) and other required reporting.
• Prepare and analyze financial projections and monthly reports to support budget development, departmental quality, and operational effectiveness.
• Maintain compliance with HRSA, CMS, HIPAA, and FQHC regulatory requirements; participate in internal and external audits as required.
• Communicate effectively with providers, front desk staff, coding teams, insurance carriers, and patients to resolve billing and claim-related issues.
• Educate staff on billing requirements, documentation standards, and workflow processes as needed.
• Maintain established productivity, accuracy, and quality standards and remain current on billing regulations, payer updates, and FQHC guidance.
• Provide front desk coverage and support front office operations as needed, under the direction of the Office Manager.
• Perform other duties as assigned to support revenue cycle operations.

Statement of Non-Inclusivity: This job description is not to be construed as a complete listing of the duties and responsibilities that may be given to any employee. The duties and responsibilities outlined in this position may be added to or changed when deemed appropriate and necessary by the supervisor.