Billing Specialist

Position Description The Billing Specialist is responsible for timely, accurate and comprehensive billing of all provider services utilizing appropriate CPT, HCPCS and ICD-10 diagnosis codes. The individual prepares and submits clean claims to Medicare, Medicaid, Commercial insurance carriers, and Self‑Pay patients and works with rejections. Duties and Responsibilities Submits claims to payers based on review of medical records and in accordance with Medicare, Medicaid, and Commercial insurance guidelines as well as FHCSWF policies and procedures. Reviews information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information to ensure clean claim submission. Enters charges accurately and expeditiously to ensure proper records handling and fast payment. Timely filing of insurance claims to clearinghouse or individual insurance companies electronically or via paper. Review and correction of claim edits within 24 hours of being received from clearinghouse and internal claims scrubber. Initiates private pay collections after insurance cancellation, denial or other issue and answers patient questions on patient responsible portions, copays, deductibles, write-offs, etc. Performs self‑pay patient billing. Prepares and sends patient statements for charges not covered by insurance. Other duties as assigned. Requirements Knowledge Demonstrated knowledge of Medicaid, Medicare, and Commercial Insurance rules and procedures in a managed care plan environment Medical terminology, CPT, HCPCS and ICD-10 coding and modifier usage Understanding of FQHC billing procedures and Sliding Fee Schedules a plus EHR systems expertise, preferably with Intergy or other ambulatory care facility-based system Understand and adhere to all HIPAA guidelines MS Office Suite (Excel proficiency) Alpha‑Numeric data entry Skills and Abilities High School or Equivalent (Associates Degree preferred) 2 Years Medical Billing experience CMRS, CPB, or CPC credentials a plus Attention to detail with strong documentation, analytic and problem‑solving skills Ability to multi-task in a fast‑paced environment Strong interpersonal written & verbal communication skill #J-18808-Ljbffr