RCM Billing Specialist

Position Summary The Accounts Receivable Billing Specialist’s purpose is to process medical billing claims of low to moderate complexity, collect patient or provider payments, resolve questions and problems with a customer’s accounts, and process patient refunds. They also handle appeals to include re-determinations and resubmissions of billing to patient payers for payment. Responsibilities Respond to requests from management, staff or providers in a timely and appropriate manner. Always maintain patient and physician confidentiality and professionalism. Scrub claims daily and submit to a clearinghouse. Generate timely submission of claims to assigned payers. Follow department policies and procedures to ensure accurate and timely claim resolution. Review and analyze A/R balances to ensure timely and accurate payments are received. Maintain current and accurate computer data including documentation of all account activities performed in system applications. Perform follow‑up with insurance companies to ensure appropriate payment on claims, resolve denials, corrected claims and appealed claims to ensure payment collection for services rendered. Bill all co‑insurance, deductible, and patient responsibility accounts per payer specific guidelines. Review, analyze, and respond to correspondence received from third‑party payers—including remittance advices, explanation of benefits, and denial letters. Document accounts with clear and concise verbiage in accordance with department procedures. Communicate effectively via telephone, email, and internal processes to resolve patient inquiries and insurance issues. Document status of billing and payment process in patient account for future follow‑up, and keep current on payer requirements via research and coaching to ensure guidelines and procedures are met for each payer. Answer and follow up on calls from patients with billing questions; complete all end‑of‑month reports as requested and directed, and complete all internal system service ticket requests as assigned. Review patient credits for resolution. Meet and exceed quality standards. Attend and participate in team meetings. Work on miscellaneous projects and tasks as needed. Perform additional duties as assigned. Qualifications Minimum of one (1) year medical insurance/healthcare billing and collections experience with a deep understanding of medical billing rules and regulations. Thorough understanding of medical billing, collections and payment posting, revenue cycle, third‑party payers, Medicare, and Medicare Advantage; strong knowledge of state and federal payer regulations. Well versed in CPT and ICD10 codes and procedural modifiers, claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes. Solid understanding of billing software and electronic medical records (EMR); ECW experience preferred. Demonstrate ability to use PC, Microsoft Office (including Word, Excel, Outlook, and Teams). Must be detail‑oriented and organized with good analytical and problem‑solving ability. Ability to function independently and as a team player in a fast‑paced environment. Must have strong written and verbal communication skills. #J-18808-Ljbffr