What are the responsibilities and job description for the Billing Specialist position at Mehta Medical Group PLLC?
About Company:
Wellspire Medical Group is a multi-specialty practice serving the Humble, Atascocita, Kingwood, Spring, Cypress, and Memorial City areas. Wellspire Medical Group provides top-tier care with compassion, kindness and respect, prioritizing patients always. – Excellence in Patient Care – Dedication to Quality – Preserving the Worth and Dignity of Every Individual
About the Role:
The Billing Specialist is responsible for reviewing and submitting medical claims to insurance companies to ensure accurate and timely reimbursement for healthcare services. This role ensures compliance with federal regulations, payer guidelines, and internal policies while maintaining the highest level of accuracy and confidentiality.
Key Responsibilities
1. Billing Duties
- Prepare and submit clean medical claims to insurance companies, clearinghouses, or government payers.
- Verify patient insurance eligibility and benefits prior to claim submission.
- Identify and correct billing errors or missing information before submission.
- Post insurance and patient payments accurately to patient accounts.
- Follow up on unpaid or denied claims within designated time frames.
- Prepare and submit corrected claims or appeals as needed.
- Balance daily billing reports and reconcile charges with payments.
2. Denials and Appeals
- Review Explanation of Benefits (EOBs) for payment accuracy and reasons for denials.
- Research and resolve denied or rejected claims promptly.
- Prepare and submit appeals with supporting documentation.
- Track and log denial trends for process improvement and training purposes.
3. Compliance and Documentation
- Maintain HIPAA compliance and protect patient confidentiality.
- Ensure adherence to all federal, state, and payer regulations (Medicare, Medicaid, and commercial).
- Participate in internal and external audits as needed.
- Keep current with billing regulations, payer updates, and compliance standards.
Qualifications
- Education: High school diploma or equivalent (required); Associate degree in Healthcare Administration or related field (preferred).
- Certification: CPC, CCA, CCS, or equivalent coding certification preferred.
- Experience: Minimum of 1–2 years of experience in medical billing
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Skills:
- Strong knowledge of CPT, ICD-10, and HCPCS Level II codes.
- Familiarity with EHR and billing software (e.g., Kareo, Athena, eClinicalWorks, Epic).
- Attention to detail and accuracy.
- Excellent communication and organizational skills.
- Ability to manage multiple tasks and meet deadlines.
Work Environment
- Office or remote setting with standard working hours (Monday–Friday).
- May require occasional overtime to meet billing deadlines or resolve outstanding claims.