Medical Billing Specialist

Full job description Medical Billing Specialist Tenderness Health Care | Shorewood, WI Full-Time Pay Range: $23–$25/hr based on experience Office location: Shorewood — 3569 N Oakland Ave, Suite B, Shorewood, WI 53211 Milwaukee — 823 S Layton Blvd, Milwaukee, WI 53215 For more than 15 years, Tenderness Health Care has been committed to providing quality care while building a workplace where employees feel valued, respected, and supported. As we continue to experience rapid growth and expand our healthcare services, we are creating new opportunities for talented professionals who want to grow with us. We are looking for an A+ team player who takes pride in their work, values teamwork and accountability, and is excited to build a long-term career with an established and growing healthcare organization. At Tenderness, your work matters, your contributions are appreciated, and there is opportunity to grow as we grow. Position Summary The Medical Billing Specialist will support billing, revenue-cycle, authorization, and related operational processes. This position helps ensure services are billed accurately and timely, outstanding claims are followed through to resolution, authorizations and recertifications are properly tracked, and billing-related workflows remain organized. The ideal candidate is detail-oriented, dependable, comfortable working across multiple systems, and able to take responsibility for tasks from beginning to completion. Medical Billing & Revenue Cycle Responsibilities Prepare, review, and submit healthcare claims accurately and timely Review billing information for completeness and accuracy before submission Cross-check billable services against submitted claims Review billable hours for accuracy and completeness Identify services that have not yet been billed Monitor rejected, denied, unpaid, and underpaid claims Research billing issues and follow them through to resolution Correct and resubmit claims when necessary Follow up with insurance companies and payors regarding outstanding claims Review accounts receivable and aging reports Assist with payment posting and reconciliation Verify eligibility and applicable payer requirements as needed Confirm required authorizations are in place before billing Review EVV and service information for billing discrepancies Identify missing or incorrect information that could delay payment Maintain detailed and accurate billing notes Assist with denial management and payment follow-up Escalate unresolved billing issues when appropriate Billing Oversight & Reporting Prepare and maintain weekly billing reports Perform billing cross-checks and identify discrepancies Review billing activity to help ensure eligible services are captured Track outstanding claims and follow-up activity Monitor billing-related tasks through completion Review accounts receivable reports Identify recurring billing issues and trends Communicate billing concerns to the appropriate departments Assist with improving billing workflows and internal processes Help ensure billing deadlines and internal expectations are met Authorizations, Referrals & Recertifications Manage assigned clients through administrative portions of the referral and authorization process Track referrals through required administrative steps Assist with gathering information needed for prior authorization submissions Track pending prior authorizations Follow up on authorization requests and outstanding documentation Monitor authorization effective and expiration dates Assist with recertification tracking and administrative processing Identify missing documentation or information Communicate outstanding items to the appropriate team members Help prevent interruptions in service related to authorization issues Maintain accurate notes and status updates Operations & Workflow Support Support team members with billing-related and operational workflow questions Assist with resolving operational tickets and follow them through completion Follow up on outstanding internal tasks Support implementation and adoption of new software and systems Assist with workflow development and process improvements Help train and support staff when new processes or systems are introduced Maintain organized tracking systems Work closely with billing, scheduling authorization, clinical, and operations teams Identify workflow issues and recommend practical solutions Help ensure information moves accurately and timely between departments Software & Systems Support Support implementation and ongoing use of healthcare software systems Assist team members with workflow questions and basic system navigation Identify system issues that may affect billing or operations Coordinate unresolved issues with the appropriate internal or external support resources Assist with testing new workflows and processes Help maintain accurate information across systems Experience with AlayaCare, Alora, Availity, EVV platforms, Monday.com, or similar healthcare systems is a plus. QualificationsRequired High school diploma or equivalent At least 1 year of medical or healthcare billing experience Working knowledge of healthcare claims and insurance billing processes Experience with claim submission, rejections, denials, and payer follow-up Basic knowledge of accounts receivable and payment processing Familiarity with CPT, ICD-10, HCPCS codes, modifiers, and medical terminology Experience working with electronic billing, EHR, or practice management systems Understanding of HIPAA and patient confidentiality requirements Strong attention to detail and accuracy Strong organizational and time-management skills Ability to manage multiple accounts, priorities, and deadlines Strong written and verbal communication skills Comfortable using Microsoft Office, Excel, email, and web-based systems Ability to research billing problems and follow issues through resolution Ability to work independently and collaboratively as part of a team Preferred 2+ years of medical billing experience Home health, home care, outpatient therapy, or other healthcare billing experience Experience billing Medicare and Medicaid Experience with managed care organizations and commercial insurance Prior authorization and recertification experience Experience with denial management and accounts receivable follow-up Experience reviewing aging reports and billing reconciliation reports EVV experience Experience supporting multiple healthcare service lines Medical billing certification such as CPB, CPC, CBCS, or similar is a plus but not required Who We’re Looking For We are looking for an A+ team player who: Wants to grow with an established and rapidly expanding healthcare organization Takes ownership of their responsibilities Pays close attention to detail Follows through until issues are resolved Does not allow important tasks to fall through the cracks Communicates proactively and professionally Supports coworkers and contributes to a positive team environment Looks for ways to improve processes Is comfortable learning new technology and systems Takes pride in accurate, organized, high-quality work Values accountability, teamwork, respect, and continuous improvement Benefits and What We Offer: Eligible employees may receive benefits in accordance with company policies and applicable plan terms, including: Competitive pay of $23.00–$27.00 per hour, based on experience Full-time employment with an established and growing healthcare organization Health benefits Paid time off, subject to company policy and eligibility Paid holidays, where applicable Opportunities for professional growth and advancement Training and professional development opportunities Exposure to multiple areas of healthcare billing, revenue cycle, and operations Opportunity to learn and work with multiple healthcare technology platforms Supportive and collaborative team environment Leadership that values initiative, accountability, and continuous improvement Opportunity to contribute ideas and help improve company processes Opportunity to grow alongside an organization experiencing rapid growth and expansion An A+ work culture focused on respect, teamwork, accountability, excellence, and continuous improvement A workplace where your work matters and your contributions are valued and appreciated Pay: $24.00 - $26.00 per hour Expected hours: 40.0 per week Benefits: 401(k) Dental insurance Health insurance Health savings account Life insurance Paid time off Vision insurance Work Location: In person #J-18808-Ljbffr Tenderness Health Care