Job Description

The Billing Specialist is responsible for overseeing the full cycle of medical billing, including claim submission, denial management, and resolution of patient billing inquiries. This role ensures timely and accurate reimbursement by collaborating with insurance providers, patients, and internal departments. The ideal candidate demonstrates strong attention to detail, proficiency in billing systems and medical coding, and a commitment to patient confidentiality and HIPAA compliance.

Essential Duties and Responsibilities

1. Submit claims to insurance payers including primary, secondary, and tertiary (e.g., Medicare, Medicaid, Blue Cross, Workers' Comp, and commercial carriers).
2. Work billing edits, front-end rejections, and denials from the clearinghouse; correct and resubmit denied or rejected claims via clearinghouse or paper.
3. Follow up on unpaid claims, file appeals, and resolve outstanding balances to ensure timely reimbursement.
4. Verify insurance coverage and benefits when needed; identify and bill secondary or tertiary insurance.
5. Process patient statements and respond to billing inquiries, ensuring timely and accurate communication.
6. Work billing-related reports from the EHR and clearinghouse to identify and resolve issues.
7. Work correspondence related to billing and insurance matters, including payer communications and documentation.
8. Research and validate payer refund requests to ensure compliance and accuracy.
9. Review patient bills for accuracy and completeness; conduct audits and reviews to ensure billing integrity.
10. Maintain patient confidentiality in accordance with HIPAA; communicate effectively with insurance companies, patients, and healthcare providers to resolve discrepancies.
11. Performs additional duties and special projects as assigned to support departmental and organizational objectives.

• Education & Training:
  • High school diploma or equivalent required
  • Associate's degree preferred
• Experience:
  • Minimum of 3 years of experience in facility billing (UB04) required
  • Prior experience in healthcare billing required
  • Demonstrated expertise in billing regulations and payer compliance requirements
• Licensure/Certification/Registration:
  • Certification in medical billing or coding preferred
• Key Skills:
  • Strong knowledge of medical terminology and coding systems (ICD-10, CPT)
  • Familiarity with insurance guidelines and reimbursement procedures
  • Excellent attention to detail and organizational skills
  • Proficiency in billing software and electronic health records (EHR)
  • Strong communication and customer service skills

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by applicable law.

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