Medical Billing Specialist

Description

Job Title

Physical Rehabilitation Network (PRN) and its Family of Brands is seeking to recruit & hire a Medical Billing Specialist I.

About Us

PRN brings together some of the most trusted PT brands across the West and Central U.S. Whether in the clinic or behind the scenes, we’re all about personalized care, smart clinical insight, and making every patient feel supported from start to finish.

About the Role

The Medical Billing Specialist I is responsible for ensuring accurate and efficient claims processing by performing detailed verification and submission of medical claims. This role supports the revenue cycle by minimizing front-end errors, preventing claim rejections, and maintaining compliance with all state, federal, and payer-specific regulations. The ideal candidate is detail oriented, dependable, and committed to maintaining high productivity and quality standards.

Duties & Responsibilities

• Ensure all claims are submitted with a goal of zero errors.
• Verify completeness and accuracy of all claims prior to submission.
• Thoroughly review patient demographic information, insurance details, and billing codes on submitted claims to identify potential errors or inconsistencies before submission.
• Check patient insurance eligibility with payors to confirm coverage and benefits prior to scheduling appointments or providing services.
• Understand and adhere to different insurance payor rules and regulations to prevent claim rejections.
• Monitor patterns of claim rejections to identify recurring issues and implement corrective actions.
• Correct rejected claims based on feedback from clearinghouse and payors and resubmit them promptly.
• Track key metrics related to front-end claim rejections and provide reports to management to identify areas for improvement.
• Check to make certain ICD codes match billing records.
• Bill Secondary claims with primary EOB attachment.
• Send out paper claims with all appropriate attachments (authorizations, Medical Records, Fee tickets, etc.).
• Perform data entry corrections when claim errors are identified.
• Audit all paper claims for appropriate billing.
• Adhere to HIPAA guidelines and Federal Privacy Law.
• Provide feedback to management regarding possible problems and areas of improvement.
• Responsible for all daily productivity reporting requirements.
• Maintain and exceed department standards for productivity and quality.
• Ensure compliance with state and federal laws and regulations for Commercial, Medicare, Medicaid, Managed Care, and other payors.
• Function effectively within a team by participating and contributing constructively to produce results in a cooperative effort.

Skills & Qualifications

• Dependability is essential: You must be able to work consistently and on time while following instructions, responding to management direction, and soliciting feedback to improve performance.
• High School Diploma or equivalent certification.
• Prior Physical/Occupational Therapy claims knowledge is preferred.
• Ability to work independently with minimal supervision as well as ability to work in a team environment.
• Skilled at managing multiple projects and grasping new concepts.
• Knowledge of healthcare industry with emphasis on medical billing.
• Medicare, Medicaid, Commercial, and Workmans Comp Insurance Knowledge.
• Computer skills and experience with Microsoft Applications.
• Accurately complete assignments while meeting deadlines.
• Excellent organizational skills.
• Excellent internal and external customer service skills.
• Must possess good oral and written communication skills and recognize importance of teamwork.
• Proficiency in Microsoft Office with Excel skills.
• Working knowledge of the NextGen System.
• Knowledge of CPT, ICD-9/ICD-10 codes.
• Knowledge of medical terminology.

Benefits & Perks

We offer a comprehensive and competitive compensation package designed to support both personal and professional well being. Team members enjoy full scale benefits—including robust Medical, Vision, and Dental plans—along with paid time off, clinical incentive opportunities, and student loan repayment options. We are committed to your continued growth and success, providing professional development resources and ongoing clinical education support.

At PRN, you’ll be part of a supportive, mission driven environment dedicated to excellence in patient care and the success of every member of our team.

Note: This job description is a general outline of responsibilities and requirements. Specific duties may vary based on the needs of management.