Billing Specialist

Job Purpose: The Billing Specialist supports the full revenue cycle by ensuring accurate claim creation, timely submission, payment posting, and resolution of outstanding balances. This role works closely with clinical, admissions, and utilization review teams to ensure clean claims, reduce denials, and support strong financial performance. A strong understanding of payer requirements and medical billing processes is essential.

Primary Responsibilities:

1. Claims Processing & Submission

   • Prepare, review, and submit clean claims to payers across all lines of business

   • Verify coding accuracy and required documentation prior to billing

   • Correct and resubmit rejected or returned claims

2. Accounts Receivable Tier 1

   • Monitor outstanding AR and follow up on unpaid or underpaid claims

   • Contact payers to resolve claim issues, discrepancies, or delays

   • Document all follow‑up activity in the billing system

3. Payment Posting & Reconciliation

   • Post insurance and patient payments accurately

   • Reconcile EOBs/ERAs and identify variances

   • Escalate payment discrepancies or trends to leadership

4. Denial Management

   • Review and analyze denial reasons

   • Prepare corrected claims or appeal packets as needed

   • Collaborate with UR, coding, and clinical teams to prevent recurring denials

1. Compliance & Quality

   • Ensure all verification processes follow payer guidelines and internal SOPs. Identify trends in coverage issues and recommend process improvements. Protect patient privacy and maintain HIPAA compliance at all times.

Education and experience, degree and/or certification required (if applicable):

1. Education and Experience:

   • High school diploma or equivalent required; associate’s or bachelor’s degree in business, finance, or related fields preferred.

   • Minimum of 1-3 years of experience in medical billing, collections, RCM, or healthcare finance.

   • CPC, CBCS or CPB certification are strongly preferred.

2. Skills and Abilities:

   • Strong understanding of insurance claim processes EOBs,CPT/HCPC, ICD-9/10 and reimbursement policies.

   • Familiarity with electronic medical records (EMR) and billing software.

   • Excellent analytical, organizational, and problem-solving skills.

   • Strong communication skills, both verbal and written.

   • Ability to work independently and manage multiple tasks effectively.

Working Relationships:

As a representative of Freeman Solutions, LLC, all comments, actions and behaviors have a direct effect on Freeman Solutions, LLC  and its image and perception of quality care for the individuals we serve.  Interactions with patient(s), staff, referral sources, guests and visitors, volunteer(s),  and supervisors must be in a manner that is friendly, supportive, courteous, respectful and professional.  This behavior should promote an atmosphere of teamwork that is congruent with Freeman Solutions, LLC policies and procedures and set a standard and guideline to promote positive relations.

I have read the above job description and agree to perform the responsibilities as described above.  I understand that this job description is intended to describe the general nature and level of work performed.  It is not intended to serve as an exhaustive list of all duties, skills and responsibilities required.