Medical Billing Specialist

Job Description

Job Description

General Information:

Job title: Medical Billing Specialist

Schedule: Full-time, 80 hours per pay period; Monday - Friday, 8:00am - 4:30pm

**Position is not eligible for remote work. Must report on-site daily.**

Weekend rotation: No Weekends

Holiday rotation: No Holidays

Position Summary:

The Medical Billing Specialist is responsible for accurately preparing, submitting, and following up on medical claims to insurance companies and patients. This role ensures timely reimbursement, compliance with healthcare regulations, and effective communication with providers, payers, and patients.

Position Responsibilities:

• Prepare, submit, and transmit clean medical claims to commercial, Medicare, and Medicaid payers (electronic and paper)
• Review and resolve accounts and pre claim edits.
• Verify patient insurance coverage and benefits.
• Review documentation and charges for accuracy and compliance.
• Monitor accounts receivable and follow up on outstanding balances.
• Follow up on unpaid, denied, or rejected claims and resolve billing issues.
• Review and reconcile account credit balances.
• Identify and correct billing errors to prevent claim rejections.
• Communicate and collaborate with coding, denial management specialists, insurance companies, patients, clinical staff and healthcare providers regarding billing inquiries or issues to ensure accurate charges, billing, and reimbursement.
• Maintain compliance with HIPAA, Medicare, Medicaid, and payer guidelines.
• Assist with patient billing questions and patient payments.
• Interpret EOBs and remittance advice.
• Maintain accurate billing records and documentation.
• Support audits and compliance initiatives when documentation.
• Perform other duties as requested.

Position Requirements:

• High school diploma or equivalent required.
• 1+ years of related work experience required.
• Experience working in the medical industry is preferred.
• Familiarity with insurance guidelines, EOBs, and claim adjudication processes.
• Proficiency with electronic health records (EHR) and billing software
• Exceptional accuracy and attention to detail required.

Knowledge, Skills, & Abilities:

• Intermediate proficiency with computers is required.
• Experience in insurance claims required.
• Knowledge of CPT, ICD-10, and HCPCS coding systems.
• Strong quantitative and analytical competency.
• Self-starter with excellent interpersonal communication and problem-solving skills.