Medical Billing Specialist

We are seeking a detail-oriented and experienced Pre-Adjudication Medical Billing Specialist to join our team in Lindenhurst, NY. In this role, you will review encounters for accurate CPT and ICD-10 coding, create and submit claims to insurance carriers, verify patient insurance eligibility, and process external medical record requests.

About Us
For the last 21 years, Quintana Family Medical, a privately owned family practice, has been providing exemplary primary medical care in Lindenhurst, NY. Our continued growth, driven by dedication to our patients, efficiency, and technology, has created the opportunity for this new position.

Responsibilities

Pre-Adjudication Billing Processes

• Review encounters and documentation to ensure accurate CPT and ICD-10 coding
• Create and submit claims for primary, secondary, and tertiary payers using proper coding rules
• Monitor and track claim transmissions, clearinghouse responses, and insurance acceptance
• Review and resolve clearinghouse or insurance alerts, rejections, and denials prior to adjudication
• Resubmit claims as required
• Review and track submission and follow up to secure timely charges

Medical Records

• Process external medical record requests, including: Receiving and validating requests Retrieving and preparing requested records Generating and issuing invoices for records Collecting and tracking payments Delivering records securely and documenting delivery
• Audit patient charts to confirm documentation supports billed services

Insurance and Benefits Eligibility

• Verify insurance and benefit eligibility
• Verify proper PCP assignment prior to patient visits
• Enter, update, and verify accurate patient primary/secondary/tertiary information in the billing system
• Communicate with patients and payers to resolve eligibility issues
• Verify, maintain, and communicate participating insurance and benefit plans

Collaboration

• Communicate and meet regularly with Post-Adjudication Billing Specialists and Department Managers
• Provide billing support to other departments as needed

Candidate Must Have

• Minimum 2 years of hands-on experience in medical billing, coding, and insurance
• Strong knowledge of CPT, ICD-10, Medicare, Medicaid, and commercial insurance rules
• Solid organizational skills with ability to manage multiple claims, record requests, and eligibility tasks simultaneously
• Proven analytical skills for reviewing claims, charges, documentation, and clearinghouse responses
• Ability to work independently and manage priorities with minimal supervision
• Ability to work in the office (on-site role)
• Ability to ascend/descend one flight of stairs to access the office

You’re a good candidate if you have:

• In-depth understanding of payer-specific billing rules (Medicare, Medicaid, commercial insurance)
• Experience using EHR and clearinghouse systems
• Proficiency with Gmail, Google Docs/Sheets, or Microsoft Word/Excel

Nice to Have:

• Experience with eClinicalWorks
• Experience with Trizetto/GatewayEDI
• Bilingual skills (English/Spanish)

Benefits

• PTO and Office holidays
• 401K with 3% Employer contribution*
• Discretionary profit sharing program*
• Monday-Friday no nights or weekends

*Profit sharing and 401k upon eligibility as per plan guidelines.

Job Type: Full-time

Pay: $45,000.00 - $52,000.00 per year

Benefits:

• 401(k)
• Employee discount
• Flexible schedule
• Paid time off
• Retirement plan

Application Question(s):

• Confirm that you understand this position is ON-SITE and requires that you ascend/descend one flight of stairs to enter the billing office?

Education:

• High school or equivalent (Preferred)

Experience:

• Medical billing: 2 years (Required)
• Medical Insurance eligibility: 2 years (Preferred)

License/Certification:

• Medical Billing Certification (Preferred)

Ability to Commute:

• Lindenhurst, NY 11757 (Required)

Work Location: In person

Salary : $45,000 - $52,000