Medical Billing and collections specialist

Billing & Collections Specialist

The Billing & Collections Specialist is responsible for supporting the financial success of the facility through accurate billing, efficient collections, and effective revenue cycle management. Under the supervision of the Business Office Director and Supervisor, this role ensures timely claim submission, reimbursement accuracy, payer compliance, and exceptional customer service while maintaining patient confidentiality and adhering to HIPAA regulations.

Key Responsibilities

Billing & Revenue Cycle

• Ensure accurate and timely billing for all payer types, admission sources, and facility locations.
• Complete claim audits for correct coding, authorization, and documentation prior to submission.
• Process claim batches through the database and clearinghouse, resolving edits and claim holds.
• Monitor clearinghouse activity and payer websites daily to track claim status and billing updates.
• Interpret payer contracts and verify payments match expected reimbursement.
• Review and analyze payer EOBs to adjudicate claims and resolve discrepancies.
• Perform daily accounts receivable review and address reimbursement issues promptly.
• Process denials, submit appeals, and manage payer correspondence.
• Maintain all required billing and collection documentation in the EHR and shared drives.

Collections & Patient Communication

• Manage collection activities to maximize revenue and meet monthly department goals.
• Communicate with patients regarding benefits, coverage issues, balances, and claim-related questions.
• Address payer issues involving coordination of benefits, third-party liability, PIP, non-coverage, or injury claims.
• Enter and maintain accurate demographic and insurance information for claims processing.
• Provide exceptional customer service to patients, physicians, and internal departments.

Workflow, Quality & Compliance

• Follow all federal, state, and accreditation standards for billing and collections.
• Maintain accurate workflows to support timely billing and reimbursement.
• Participate in department meetings, staff training, and competency education.
• Support month-end processes in patient accounting software.
• Ensure all internal controls are followed and maintain compliance with policies and procedures.
• Assist with new staff orientation and contribute to a positive team environment.

Professionalism & Teamwork

• Maintain a professional appearance, demeanor, and confidentiality in all interactions.
• Demonstrate accountability, adaptability, and a willingness to learn and assist as needed.
• Participate in team-based decision-making and respond positively to workflow changes.
• Exercise tact, patience, and strong communication skills in high-stress situations.

Qualifications

• High school diploma or equivalent required.
• Minimum one year of medical business office experience (billing, collections, or related activities).
• Strong knowledge of medical billing, coding, authorizations, payer requirements, and revenue cycle processes.
• Excellent verbal and written communication skills in English.
• Proficiency with Microsoft Office, patient accounting systems, and general office equipment.
• Ability to perform basic math, interpret payer contracts, and understand medical terminology.
• Prior cash-handling or collections experience preferred.
• Ability to type at least 20 WPM.