Medical Billing Assistant

Medical Billing Assistant

Established in 1971, HealthQ has been a trailblazing and trusted non-profit organization providing sexual and reproductive healthcare in Massachusetts' North Shore and Merrimack Valley for over 50 years. At HealthQ, we are committed to providing exceptional reproductive and sexual health care to all who need it without judgment and without barriers. We provide birth control, abortion, gender-affirming care, STI testing and treatment, vasectomies, HIV testing and referral, and other preventive health services.

The Medical Billing Assistant supports front-end revenue cycle operations for the health center, ensuring accurate insurance verification, prior authorization, charge review, and claim submission. This role works within the practice management tools of athenahealth to review encounters, submit claims, and respond to patient billing inquiries.

The Medical Billing Assistant also serves as a key liaison with the organization's third-party billing vendor, which manages denial resolution, payment posting, and accounts receivable. This position helps ensure claims are submitted accurately and promptly and that eligibility, authorization, and patient account issues are addressed before claims are processed.

This role requires strong attention to detail, comfort working with insurance payers, and a commitment to providing patient-centered support in a reproductive health care environment.

Essential Duties and Responsibilities

Charge Review and Claim Submission

• Review encounters and charges for completeness and accuracy prior to claim submission.
• Ensure appropriate CPT, HCPCS, and ICD-10 codes are documented.
• Submit claims through athenahealth.
• Address claim edits and submission errors prior to transmission.

Billing Operations

• Review encounters in athenahealth to ensure charges, modifiers, and documentation are complete prior to claim submission.
• Monitor claim status and work queues within the EHR/practice management system.
• Identify and resolve claim edits, rejections, and denials in collaboration with the third-party billing company.
• Submit corrected claims and assist with appeals when necessary.
• Track and follow up on unpaid or delayed claims.

Coordination with Third-Party Billing Vendor

• Serve as the primary liaison between the clinic and the external billing company.
• Communicate claim issues, coding questions, and documentation needs to the billing vendor.
• Review vendor reports related to claim submission, denial trends, and revenue cycle performance.
• Escalate unresolved billing issues to leadership when necessary.

Charge Review and Coding Support

• Review encounter documentation to ensure accurate CPT, HCPCS, and ICD-10 coding.
• Flag potential coding discrepancies and work with clinical staff to correct them.
• Assist in maintaining billing guidelines specific to reproductive and sexual health services.

Patient Billing Support

• Respond to patient billing inquiries and assist with understanding statements and insurance coverage.
• Support correction of insurance information when claims are rejected due to eligibility or demographic issues.
• Coordinate with front desk teams to resolve patient account discrepancies.

Insurance Verification and Eligibility

• Verify patient insurance coverage and eligibility prior to services.
• Review payer requirements and confirm coverage details including copays, deductibles, and prior authorization requirements.
• Ensure patient demographic and insurance information is accurate in athenahealth.
• Monitor eligibility work queues and resolve coverage issues before services are billed.

Prior Authorization

• Obtain prior authorizations for services when required by insurance plans.
• Submit clinical documentation to payers as needed.
• Track authorization status and ensure approvals are documented in the patient record.
• Coordinate with clinical staff and scheduling teams to ensure services requiring authorization are approved in advance.

Reporting and Quality Assurance

• Run basic billing and claim reports within the practice management system.
• Monitor denial trends and flag recurring issues.
• Support internal audits of billing practices and documentation.

Compliance

• Maintain compliance with payer requirements and federal/state regulations.
• Protect patient confidentiality in accordance with the Health Insurance Portability and Accountability Act.
• Follow organizational policies related to reproductive health confidentiality and billing.

Other Responsibilities

Perform other duties as assigned.

Qualifications & Skills

Experience/Skill Requirements

• Minimum of 3 years of experience in medical billing or revenue cycle support.
• Experience with electronic health records (EHR) and billing systems, preferably athenahealth.
• Knowledge of CPT, ICD-10, and HCPCS coding basics.
• Familiarity with insurance claims processes, denials, and appeals.
• Knowledge of Medicaid, Medicare, and commercial insurance reimbursement policies.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities and meet deadlines.
• Commitment to reproductive health care, equity, and social justice.

Education/Knowledge Requirements

• Certification such as Certified Professional Coder (CPC) or Certified Billing and Coding Specialist (CBCS) is a plus.
• Experience in sexual and reproductive health or community health.
• Experience working with an outsourced or third-party billing company.
• Bilingual preferred, especially Spanish.

Compensation and Benefits

The compensation range for this position is $23.04 - $28.80 and the starting salary offer will primarily be determined by the years of experience the candidate brings to the role. HealthQ offers annual increases.

• Health insurance for employees and dependents (75% employer-paid)
• Dental and vision insurance
• Vacation (2 weeks) and sick (2 weeks) time
• Retirement plan (3% match after 1 year)
• Self-care benefit reimbursement
• Education reimbursement and more.

Work Schedule

This position works fully on-site. HealthQ's health centers are open Monday - Friday between 8:30 am and 7:30 pm. The position offers some flexibility in determining a work schedule that aligns with staff and organizational needs. Occasional early morning, evening, and weekend hours may be required based on organizational and project needs.

Physical Requirements

The physical requirements described here are representative of those that must be met by the employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the employee is regularly required to utilize devices for data entry. The employee is frequently required to stand; sit; use hands to finger, handle, or feel and reach with hands and arms. The employee may occasionally be asked to lift up to 25 pounds. The vision requirements include: close vision, color vision and depth perception and the ability to read 10 point or larger type. The employee must be able to hear and speak in a manner understood by most people and must communicate effectively in English both orally and in writing sufficient to prepare and send reports, and to interact with staff and peers. The employee must be able to use customary office equipment and software.

Work Environment

The work environment characteristics described here are representative of those the employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job the employee is required to take normal safety precautions, such as avoidance of falls, etc. The employee is exposed to infection on a rare to occasional basis. The work area is adequately lit, heated, and ventilated. The noise level in the environment is moderate.

Regular travel to conduct business is necessary.

To Apply

Candidates should submit a cover letter outlining their interest and qualifications, along with a resume. Applications will be reviewed on a rolling basis. There will be 3 rounds of interviews. The process will include a screening interview with a member of HealthQ's team, two subsequent rounds of interviews with members of the HealthQ team, including a final round of interviews in person. Our desired start date for this candidate is June 2026.