Billing Specialist

Medical Billing Specialist

Revenue Cycle Management is looking for a Medical Billing Specialist to join our team! Hybrid opportunity after 90 days of in-person training (2 days from home, 3 days in office).

SUMMARY: The Medical Billing Specialist is responsible for analyzing patients records and coding the patients records based on ICD-10 and CPT codes. Additionally, ensure all charges are reflected on the patient account and communicate with inter-departments regarding any type of discrepancy for corrections.

ESSENTIAL FUNCTIONS:

• Reviews patient accounts and supporting documentation to ensure all billable services and charges are captured accurately
• Validates diagnosis and procedure codes on accounts for billing accuracy and payer requirements; escalates discrepancies for correction
• Communicates with clinical, coding, and front-end teams to obtain or clarify missing or incomplete information
• Prepares and submits accurate electronic and paper claims to commercial insurance carriers and government payers
• Investigates and resolves claim denials and rejections, including appropriate corrections and resubmissions
• Maintains accurate and up-to-date patient account information within the electronic medical record (EMR) and billing systems
• Identifies trends or recurring issues impacting reimbursement and communicates findings to leadership
• Ensures compliance with payer guidelines, company policies, and applicable regulations
• Perform other related tasks as needed

KNOWLEDGE, SKILLS, AND ABILITIES:

• Knowledge of medical billing processes, including insurance verification, prior authorization, patient responsibility, and workers compensation
• Knowledge of explanation of benefits (EOBs), remittance advice, and coordination of benefits (COB) processing
• Working knowledge of medical terminology and ICD-10, CPT, and HCPCS coding systems as they relate to billing accuracy
• Knowledge of payer guidelines, including government and commercial insurance requirements, claims submission, and denial management
• Proficient in electronic billing systems and claim forms, including HCFA Form CMS-1500
• Experience with electronic medical records (EMR) and practice management systems
• Strong analytical and problem-solving skills with the ability to identify and resolve billing discrepancies
• High attention to detail and accuracy in reviewing and processing claims
• Strong organizational and time management skills with the ability to prioritize tasks effectively
• Ability to work independently with minimal supervision and adapt to changing priorities
• Effective written and verbal communication skills, including the ability to communicate professionally with internal teams and external parties
• Proficient in Microsoft Office applications, including Word, Excel, and PowerPoint

EDUCATION AND EXPERIENCE:

• High School Diploma or GED
• Three (3) years of experience with medical billing, accounts receivable, or revenue cycle operations
• Medical billing certification in lieu of experience

BENEFITS:

• 3 Medical Plans
• 2 Dental Plans
• 2 Vision Plans
• Employee Assistant Program
• Short- and Long-Term Disability Insurance
• Accidental Death & Dismemberment Plan
• 401(k) with a 2-year vesting
• PTO + Holidays

Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data. Employment for this position is contingent upon the successful completion of a background check and drug screening.