Billing Specialist

Billing Specialist

The Billing Specialist is responsible for accurate and timely submission of medical claims, and follow-up with payers and patients. This role ensures compliance with HIPAA and payer regulations while supporting efficient revenue cycle operations.

Key Responsibilities

• Prepare, review, and submit clean claims to insurance payers (CMS-1500 and/or UB-04)
• Verify patient insurance eligibility and coverage
• Ensure accuracy of patient demographics, charges, and modifiers
• Submit claims electronically and track claim status
• Research claim denials and rejections
• Correct errors and resubmit claims in a timely manner
• Prepare and submit appeals with supporting documentation
• Generate and review patient statements
• Respond to patient billing inquiries professionally and clearly
• Maintain compliance with HIPAA Privacy and Security Rules
• Protect the confidentiality of all patient information
• Out of network billing preferred but not required
• Knowledge of Federal and State guidelines regarding NSA and TDI claims