Billing Specialist II

Billing Specialist II

The Billing Specialist II is responsible for advanced billing functions, including comprehensive claim review and submission, managing complex cases, and ensuring compliance with detailed payer requirements. This role also supports training of junior billing staff, participates in audits, and assists in refining processes to support accurate reimbursement and compliance.

Essential Duties and Responsibilities

• Verify patient demographic and insurance data, including complex or non-standard cases.
• Prepare, review, and submit electronic and paper claims to a variety of payers and government programs.
• Identify and resolve standard and complex claim rejections.
• Maintain current knowledge of internal billing protocols, coding updates, and payer-specific requirements.
• Enter and review census data from multiple facilities in Monday.com and billing platforms.
• Follow established billing procedures and escalate irregular issues as needed.
• Provide guidance to entry-level billing specialists to support team operations.
• Participate in internal audits and recommend adjustments to billing policies and workflows.
• Maintain compliance with HIPAA and data privacy regulations.
• Manage multiple assignments with a focus on quality and completion within required timeframes.

Qualifications

• High school diploma or equivalent.
• Minimum of 3+ years of experience in medical billing with advanced responsibility in key billing areas.
• Professional certifications such as CPB, CMC, or equivalent that demonstrate billing and coding knowledge.
• Participation in ongoing education related to billing, coding, or healthcare finance.

Key Competencies

• Data Accuracy and Review: Ability to manage complex data, identify discrepancies, and ensure billing accuracy.
• Medical Coding and Billing: Knowledge and correct application of CPT, ICD-10, HCPCS codes, modifiers, and current coding guidelines.
• Payer Regulations: Understanding of payer billing requirements and coordination of benefits processes.
• Guidance and Support: Ability to assist and support Billing Specialist in billing processes.
• Issue Resolution and Coordination: Skills in resolving billing issues and working with internal departments to maintain timely claim processing.