Medical Biller and Claims Specialist

Job Overview
We are seeking a dynamic and detail-oriented Medical Biller and Claims Specialist to join our team. In this vital role, you will be responsible for managing the entire billing process, ensuring accurate and timely submission of claims to insurance companies, government programs, and patients. Your expertise will help optimize revenue cycles and improve patient satisfaction by resolving billing issues efficiently. If you thrive in a fast-paced environment and have a passion for healthcare finance, this is the perfect opportunity to make a meaningful impact.

Duties

• Prepare and submit medical claims using Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems, ensuring compliance with insurance requirements and if necessary, on paper CMS 1500 Forms
• Mail CMS 1500 Forms to insurance carriers
• Review patient records to accurately code diagnoses and procedures utilizing CPT coding, ICD-9, ICD-10, and DRG classifications.
• Verify insurance coverage, eligibility, and benefits prior to billing to prevent claim denials.
• Communicate with insurance carriers (i.e., MassHealth, Commonwealth Care Alliance, Fallon Health, Tufts Health Plan, Molina (former Senior Whole Health), United Health Care, and Mass General Brigham Health Plan, to resolve billing issuesFollow up on unpaid or denied claims through effective communication with insurance providers and patients to facilitate prompt resolution.
• Maintain detailed records and documentation related to billing activities, ensuring accuracy and confidentiality.
• Collaborate with medical office staff to update patient information and ensure proper coding for medical procedures.
• Stay current with industry regulations, coding updates, and payer policies to ensure compliance and maximize reimbursement requirements
• Proven experience in medical billing, coding, or related healthcare administration roles.
• Strong knowledge of DRG systems, CPT coding, ICD-9, ICD-10, and medical terminology.
• Familiarity with EMR/EHR systems used for medical records management and billing processes.
• Excellent understanding of medical collection procedures and insurance claim submission workflows.
• Ability to interpret complex medical records accurately for proper coding and billing purposes.
• Prior experience working in a medical office environment is preferred.
• Strong organizational skills with attention to detail and accuracy in all tasks.
• Work independently and as a team member, problem solve, take initiative and be reliable efficiency in healthcare revenue management while supporting exceptional patient care!

Compensation & Benefits:

• Established Reputation: Serving Healthcare providers in Massachusetts
• Pay: $18.00–$22.00/hour
• Job Type: Part-time, 10-15 hours a week
• Schedule: Monday through Friday
• Flexible Hours
• 8 Paid Holidays
• Location & Amenities: Accessible office, Dorchester, MA with parking.
• On the MBTA Commuter Rail Line, Red Line and Orange Line

Minimum Qualifications:

• 2 years of experience in medical billing preferred (training available for entry-level)
• Strong understanding of EOBs, insurance guidelines, and claim processes
• Proficiency with billing software and EHR systems (Inovalon, Payspan, Myability, Availity, Allscripts, Epic, etc.)
• Excellent attention to detail, time management, and communication skills
• High school diploma or equivalent; certification in billing/coding preferred
• Ability to work independently and stay motivated
• Maintain a 98% clean claim rate

Pay: $18.00 - $22.00 per hour

Benefits:

• Flexible schedule

Work Location: In person

Salary : $18 - $22