Medical Billing Specialist

Medical Billing Specialist

Position Summary: The Medical Billing Specialist is responsible for managing the full medical billing cycle to ensure timely and accurate reimbursement for services rendered. This role includes reviewing patient information, preparing and submitting insurance claims, resolving billing discrepancies, and maintaining compliance with healthcare regulations. The Medical Billing Specialist works closely with providers, patients, and payers, including Medicare and Medicaid, to support efficient revenue cycle operations. Status: Full-Time, 40 hours/week Schedule: Monday Friday, 9:00 AM 5:00 PM Pay Rate: $19.24/hour

Essential Duties & Responsibilities:

• Review patient encounter forms for accuracy and completeness prior to claim submission
• Collaborate with providers and internal teams to obtain required billing information
• Submit and manage claims for managed care, commercial insurance, Medicare, and Medicaid
• Verify insurance coverage and eligibility
• Post charges and payments daily from patients and insurance carriers
• Research, resolve, and follow up on denied or unpaid claims, including appeals and rebilling
• Respond to patient billing inquiries and resolve discrepancies professionally
• Maintain accurate patient demographic and billing records in the Electronic Medical Record (EMR)
• Monitor accounts receivable for inconsistencies and initiate corrective actions
• Ensure coding accuracy and compliance with legal and payer requirements
• Stay current on billing and coding rule changes
• Prepare and maintain billing and accounts receivable reports
• Adhere to organizational policies, procedures, and confidentiality standards
• Perform other duties as assigned

Qualifications:

• High school diploma required; Associate's or Bachelor's degree preferred
• Minimum of 2 years of experience in medical or electronic billing
• Medical billing and coding certification preferred
• Knowledge of Medicare, Medicaid, and third-party billing practices (Pennsylvania experience preferred)
• Proficiency in Microsoft Word, Excel, and healthcare billing systems
• Strong attention to detail, analytical, and problem-solving skills
• Excellent communication, customer service, and organizational skills
• Ability to manage deadlines and work independently while maintaining accuracy