Medical Billing Specialist

Job Summary

We are seeking a detail-oriented and proactive Medical Billing Specialist to join our healthcare team. In this vital role, you will work with the billing process, ensuring accurate and timely submission of claims to insurance companies and patients. Your expertise will help optimize revenue cycles, resolve billing discrepancies, and improve overall financial performance. This position offers an exciting opportunity to contribute to efficient healthcare claims management while maintaining excellent customer service standards. The ideal candidate will possess strong medical coding skills, familiarity with EMR/EHR systems, and a solid understanding of health insurance processes.

Essential Duties and Responsibilities:

• Prepare and submit accurate medical claims using billing software, ensuring compliance with coding standards such as CPT (Current Procedural Terminology), ICD-10 (International Classification of Diseases).
• Review billing documentation for completeness and accuracy before entering or submitting information.
• Reviews claims for accuracy in accordance with Medicare, Medicaid and Managed Care policies and guidelines.
• Review claims and identify missing, incomplete, or inconsistent information for basic data-entry errors, including incorrect patient information, insurance details, dates of service, provider information, and billing codes and communicate with appropriate department for clarification or correction.
• Review, research, and ensure corrections are made on denied claims due to missing or incorrect information.
• Communicate professionally with internal departments regarding missing documentation or billing concerns.
• Enter payments, contractual adjustments, write-offs, and other account updates as required by Medicare, Medicaid, HMO and PPO as assigned.
• Assist with insurance collection (follow-up) function utilizing the collection system management and aging reports. As a part of this function, generates and reviews aging reports to submit to insurance carriers when appropriate and in accordance with established guidelines.
• Transfers balances to patient's responsibility on non-covered items, benefits denied or charges applied to the deductible as assigned.
• Assist with all incoming patient correspondence and answer all patients' questions regarding their account balance.
• Assist and prepare refund paperwork for accounts payable and enter adjustments into billing system as assigned.
• Verify that third-party payer payments comply with contract terms and current reimbursement rates.
• Makes necessary adjustments to correct patient accounts for corrected billing.
• Maintain accurate and organized electronic billing records.
• Scan, upload, and properly categorize billing documents within the designated system.
• Assist with collections, and answering billing related questions.
• Assist with reconciling billing reports and identifying discrepancies.
• Complete tasks in assigned work queues within established turnaround times.
• Maintain the confidentiality of patient, financial, and organizational information.
• Follow HIPAA requirements, organizational policies, and all applicable billing and compliance procedures.
• Participate in training and process-improvement activities as required.
• Perform additional billing or administrative duties as assigned.

Required Qualifications:

• High school diploma or equivalent required.
• Two (2) years of medical billing and collection background and experience in a physician practice setting is required.
• Alternatively, a combination of completed education in medical billing and coding and experience in any of the following areas: charge posting, claim creation and adjustments, collections, payment arrangements, payment posting, or insurance verification.
• Maintains current knowledge of all Medicare/Medicaid policies and procedure updates.
• Experience working with electronic health records, practice management systems, or billing software is required, experience with EClinical Works (ECW) preferred.
• Must have basic knowledge of medical terminology.
• Must have good communication, customer service skills, the ability to read, understand, and follow oral and written instructions.

Performance Expectations:

• Maintain accurate and complete billing records.
• Meet established productivity and turnaround-time requirements.
• Minimize data-entry errors that may delay claim submission or payment.
• Complete assigned work queues within established deadlines.
• Promptly report recurring documentation or billing issues.
• Maintain professional communication with employees, providers, patients, and external parties.
• Follow all privacy, security, compliance, and departmental procedures.

Join us in making a difference by ensuring smooth financial operations that support quality patient care!

Expected hours: 40.0 per week

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $37,903 - $52,764