What are the responsibilities and job description for the Billing Specialist position at Evening Pediatrics Inc?
The Medical Billing Specialist supports a high-volume pediatric urgent care practice with a strong Medicaid and managed Medicaid payer mix. This role is responsible for accurate coding, claim submission, and follow-up for episodic urgent care visits, procedures, and ancillary services, ensuring timely reimbursement while maintaining compliance with Medicaid and payer-specific requirements.
Key Responsibilities
- Review urgent care provider documentation and assign accurate CPT, ICD-10, and HCPCS codes
- Bill high-volume pediatric urgent care services, including E/M levels, minor procedures, splinting, laceration repair, and diagnostic services
- Submit and manage claims primarily for Medicaid and Medicaid MCOs, with some commercial payers
- Apply correct modifiers for urgent care services, procedures, and multiple services rendered in a single visit
- Verify Medicaid eligibility, managed care enrollment, and urgent care coverage rules
- Identify, research, and resolve denials related to medical necessity, bundling, modifiers, frequency limits, and timely filing
- Prepare and submit corrected claims and appeals in accordance with state Medicaid guidelines
- Post payments, contractual adjustments, and reconcile ERAs/EOBs
- Monitor accounts receivable, track claim aging, and prioritize timely follow-up
- Work closely with clinical and front-office teams to resolve documentation, registration, or coding issues
Qualifications
- High school diploma or equivalent (Associate degree preferred)
- Minimum 2 years of medical billing experience in urgent care, emergency, or pediatric physician practice settings
- Strong experience with Medicaid and managed Medicaid billing
- Solid understanding of urgent care E/M coding, procedure coding, and modifier usage
- Experience with EHR/EMR and practice management systems
- Ability to work accurately in a fast-paced, high-volume environment
Preferred Certifications
- Certified Professional Biller (CPB)
- Certified Medical Reimbursement Specialist (CMRS)
- Urgent care or pediatric billing experience strongly preferred
Skills & Competencies
- Knowledge of Medicaid urgent care policies and payer-specific edits
- Strong denial management and appeal skills
- High attention to detail with excellent time-management
- Clear communication with payers, providers, and operational staff
- Commitment to compliance, accuracy, and patient confidentiality