Medical Billing Specialist

Position Summary

The Medical Billing Specialist is responsible for the accurate and timely processing of medical claims, insurance follow-up, payment posting support, denial resolution, and patient account management. This position plays a vital role in the revenue cycle by ensuring services are billed appropriately, reimbursements are received promptly, and payer requirements are met.

The Medical Billing Specialist works collaboratively with providers, clinical staff, coders, patient access, and insurance companies while maintaining a high level of professionalism, confidentiality, and customer service.

Essential Duties and Responsibilities

Claims Processing

• Prepare, review, and submit electronic and paper claims accurately and timely.
• Review claims for completeness, accuracy, and compliance with payer guidelines before submission.
• Monitor claim status and identify claims requiring follow-up.
• Correct and resubmit rejected or denied claims.
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to ensure accurate reimbursement.

Accounts Receivable Management

• Follow up on unpaid, underpaid, denied, or delayed claims.
• Research payment discrepancies and resolve billing issues with insurance carriers.
• Maintain assigned accounts receivable work queues and aging reports.
• Document all account activity thoroughly within the billing system.
• Assist in meeting departmental collection and productivity goals.

Insurance & Billing Support

• Verify insurance eligibility and benefits when needed.
• Understand payer-specific billing rules and reimbursement policies.
• Review documentation to ensure services are supported for billing.
• Assist with prior authorizations, referrals, or payer inquiries as assigned.

Patient Account Services

• Respond professionally to patient billing inquiries.
• Explain insurance payments, patient balances, deductibles, and financial responsibility.
• Process patient payments according to office policy.
• Maintain confidentiality of patient financial and medical information.

Compliance & Quality

• Maintain compliance with HIPAA and all applicable federal and state regulations.
• Follow Medicare, Medicaid, commercial insurance, and payer billing guidelines.
• Report billing concerns or compliance issues to management.
• Maintain accuracy while meeting established productivity standards.

Teamwork & Communication

• Work collaboratively with providers, coding staff, front office personnel, and leadership.
• Communicate recurring billing issues and payer trends.
• Participate in department meetings, education, and process improvement initiatives.
• Assist with training and mentoring new employees as requested.

Administrative Responsibilities

• Maintain accurate billing documentation and electronic records.
• Scan, upload, and organize supporting documentation.
• Complete assigned reports and special projects.
• Perform other duties as assigned to support departmental operations.

Required Qualifications

• High school diploma or GED required.
• One to two years of medical billing experience preferred.
• Working knowledge of ICD-10-CM, CPT, and HCPCS coding.
• Experience with Electronic Health Record (EHR) and/or Practice Management software.
• Knowledge of insurance billing, claims processing, and reimbursement practices.
• Proficiency with Microsoft Office applications (Excel, Word, Outlook).
• Strong organizational, analytical, and problem-solving skills.
• Excellent attention to detail and accuracy.
• Effective verbal and written communication skills.
• Ability to prioritize multiple tasks, meet deadlines, and work independently as well as within a team.

Preferred Qualifications

• Experience working in a specialty medical practice.
• Familiarity with Medicare, Medicaid, commercial insurance, and workers' compensation billing.
• Experience with claim denial management, appeals, and accounts receivable follow-up.
• Experience assisting with onboarding or training new employees.

Knowledge, Skills & Abilities

The Medical Billing Specialist should demonstrate:

• Knowledge of medical terminology and healthcare billing practices.
• Understanding of insurance regulations and payer requirements.
• Strong analytical and critical-thinking skills.
• Exceptional attention to detail and accuracy.
• Professional communication and customer service skills.
• Ability to maintain confidentiality of patient and organizational information.
• Effective time management and organizational abilities.
• Adaptability to changing healthcare regulations, payer requirements, and organizational priorities.
• Ability to work independently while contributing positively to a team environment.

Performance Expectations

Employees in this position are expected to:

• Submit claims accurately and within established timelines.
• Maintain a high level of billing accuracy.
• Resolve claim denials and payment issues promptly.
• Meet departmental productivity and quality standards.
• Demonstrate professionalism in all interactions with patients, coworkers, providers, and insurance representatives.
• Follow organizational policies, attendance standards, and confidentiality requirements.
• Participate in ongoing education and training to remain current with billing regulations and payer updates.
• Contribute to a positive, collaborative, and service-oriented work environment.

Physical Requirements

• Ability to sit for extended periods while performing computer-based work.
• Frequent use of a computer, keyboard, telephone, and other standard office equipment.
• Ability to communicate effectively in person, by telephone, and electronically.
• Occasionally lift or move office materials weighing up to 20 pounds.

Working Conditions

• Office or healthcare clinic environment.
• Frequent computer and telephone use.
• Fast-paced environment with productivity expectations and deadlines.
• Frequent interaction with patients, providers, insurance companies, and coworkers.

Core Competencies

• Accountability
• Integrity and Ethics
• Customer Service
• Teamwork and Collaboration
• Communication
• Attention to Detail
• Time Management
• Problem Solving
• Adaptability
• Professionalism
• Continuous Learning

Disclaimer

This job description is intended to describe the general nature and level of work performed by employees assigned to this position. It is not intended to be an exhaustive list of all duties, responsibilities, or qualifications. Management reserves the right to modify, assign, or remove duties as business needs change.

Pay: $23.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Employee discount
• Health insurance
• Paid time off

Work Location: In person

Salary : $23