Medical Billing Specialist

Job Description

Job Description

POSITION SUMMARY

The Medical Billing Specialist is responsible for managing the billing and collections process within established timeframes to ensure timely and accurate reimbursement for services provided by Pain & Rehabilitative Consultants Medical Group (PRCMG). This role reviews and submits insurance claims, resolves billing discrepancies, follows up on unpaid or denied claims, and manages aging accounts within established timeframes to support the organization’s revenue cycle operations. The Medical Billing Specialist works closely with the Billing Manager and other departments to ensure compliance with payer guidelines, including Medicare and Workers’ Compensation. The ideal candidate is detail-oriented, organized, and able to manage multiple priorities in a fast-paced healthcare environment while maintaining a high level of accuracy and professionalism.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Prepare, review, and submit accurate insurance claims for services rendered within established timelines to facilitate timely reimbursement.
• Review claims for errors or missing information and make necessary corrections prior to submission.
• Monitor claim status and follow up with insurance carriers on unpaid, denied, or underpaid claims.
• Review Explanation of Benefits (EOBs) to identify denials, underpayments, or coding discrepancies and take appropriate action.
• Prepare and submit appeals for denied or incorrectly processed claims and track the status of submitted appeals.
• Conduct follow-up with insurance companies regarding pending claims, appeals, and payment discrepancies.
• Manage and review assigned accounts on the aging report and take appropriate follow-up actions to resolve outstanding balances.
• Prepare tracers and documentation for unanswered appeals and maintain accurate records of follow-up activities.
• Process incoming correspondence related to patient accounts, including updated insurance information, payment inquiries, and payer communications.
• Update and maintain accurate billing records and patient account information in the billing system.
• Work collaboratively with the Billing Manager to address complex billing issues and participate in special billing projects as needed.
• Stay informed of current payer guidelines, billing regulations, and reimbursement policies related to Medicare, Medi-Cal, commercial insurance, and Workers’ Compensation.
• Attend department meetings and participate in ongoing training or educational opportunities to maintain billing knowledge and compliance.
• Maintain confidentiality of patient information and comply with HIPAA and organizational policies.
• Perform additional duties and responsibilities as assigned to support the revenue cycle and billing operations.

Qualifications Required (Education, Experience, AND Skills)

• High school diploma or GED required.
• Minimum three (3) years of medical billing experience in a healthcare or medical office setting.
• Working knowledge of medical terminology, CPT, and ICD-10 coding.
• Experience reviewing Explanation of Benefits (EOBs) and resolving claim denials, underpayments, and billing discrepancies.
• Knowledge of Medicare, commercial insurance, PPO, and HMO billing regulations and guidelines.
• Proficiency with medical billing software and electronic health record (EHR) systems.
• Strong Microsoft Office skills, particularly in Word and Excel.
• Strong attention to detail with the ability to maintain accuracy while managing a high volume of accounts.
• Ability to manage deadlines and prioritize tasks in a fast-paced environment.
• Strong communication and problem-solving skills when interacting with insurance representatives and internal teams.
• Ability to work independently and collaboratively within a team environment.
• Demonstrated professionalism, reliability, and strong organizational skills.

PREFERRED

• Workers’ Compensation billing and collections experience.
• Working knowledge of OMFS (Official Medical Fee Schedule) and Workers’ Compensation appeals processes.
• Experience using MediTab IMS or similar medical billing systems.
• Certified Professional Coder (CPC) or similar certification.
• Experience working in a multidisciplinary or specialty medical group practice.

Pain & Rehabilitative Consultants Medical Group (PRCMG) is a leading Northern and Central California practice providing comprehensive, evidence-based pain management and rehabilitative care through a multidisciplinary team dedicated to improving function and quality of life.

Company Description

Pain & Rehabilitative Consultants Medical Group (PRCMG) is a leading Northern and Central California practice providing comprehensive, evidence-based pain management and rehabilitative care through a multidisciplinary team dedicated to improving function and quality of life.