Medical Billing Specialist

Medical Billing Specialist

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

The Medical Billing Specialist is responsible for analyzing patient's records and coding the patient's 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