Medical Billing Specialist

Position Overview

The Insurance/Billing Specialist is responsible for managing all aspects of insurance verification, billing, and collections within a pediatric outpatient therapy setting. This role ensures accurate claim processing, efficient collections, and excellent communication with both families and insurance carriers. The ideal candidate is detail-oriented, compassionate, and experienced in navigating the complexities of pediatric therapy billing and insurance procedures.

Primary Responsibilities

· Verify patient insurance benefits and eligibility for therapy services, including physical, occupational, and speech therapy.

· Obtain and track prior authorizations and re-authorizations for ongoing pediatric therapy services.

· Accurately post charges, payments, and adjustments into the Electronic Medical Record (EMR) and billing systems.

· Review and reconcile Explanation of Benefits (EOB) and remittance advice from insurance carriers.

· Research, appeal, and resolve denied or delayed claims by consulting with insurance representatives and communicating updates to patients and staff.

· Initiate private pay collections and coordinate payment plans, following expressed permission from administrators, for families when insurance coverage is denied, canceled, or incomplete.

· Prepare and distribute weekly statements for patient accounts and respond to parent inquiries with professionalism and empathy.

· Maintain up-to-date knowledge of payer policies, therapy coverage limits, and medical necessity guidelines.

· Communicate regularly with therapists and administrative staff regarding patient eligibility, authorizations, and billing status.

· Conduct monthly insurance re-verifications for active patients to ensure continued coverage.

· Ensure compliance with HIPAA and all applicable state and federal regulations.

Qualifications

· Some college coursework required; an associate’s or bachelor’s degree in business, healthcare administration, or related field preferred.

· Minimum of 1–2 years of experience in medical billing, preferably in pediatric therapy or rehabilitation services.

· Strong understanding of insurance processes, including pre-authorizations, EOBs, denials, and appeals.

· Proficiency with EMR and billing software, as well as insurance portals and Microsoft Office Suite.

· Excellent interpersonal and communication skills, with the ability to work compassionately with families.

· Strong organizational skills and attention to detail.

· Ability to work independently and maintain productivity without direct supervision.

· Knowledge of HIPAA and patient confidentiality requirements.

Preferred Qualities

· Experience working in a pediatric or therapy-based healthcare environment.

· Familiarity with Medicaid and commercial insurance requirements for therapy services.

· Customer-service mindset with a positive and professional demeanor.

Job Types: Full-time, Part-time

Pay: $14.00 - $18.83 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Ability to Relocate:

• Basehor, KS 66007: Relocate before starting work (Required)

Work Location: In person

Salary : $14 - $19