Claims Specialist and Billing Associate

Job Description

Job Description

The Claims Specialist/Billing Associate is responsible for assisting the Billing Manager in managing the billing and reimbursement process for rendered healthcare services. The role is also responsible for administering insurance claims, insurance and patients payments, and explaining service charges and post-insurance adjudication outcomes. This role ensures accurate claim submission, timely payment collection, and compliance with insurance and regulatory requirements.

• Preparing and submitting medical claims to insurance companies (electronic and paper)
• Communicate with insurance companies regarding claim status and appeals
• Reviewing and resolving insurance claim denials in a timely and accurate manner
• Investigating denial reasons and taking corrective action for resubmission or appeal
• Locating pending or missing insurance payments and following up with payers regarding claim status
• Researching payment discrepancies and underpayments from insurance carriers
• Submitting corrected claims, appeals, and supporting documentation as necessary
• Monitoring aging accounts receivable and prioritizing outstanding claims for follow-up
• Maintaining accurate documentation of billing activity, payer communication, and account notes
• Assisting in identifying billing trends, recurring denials, and workflow improvement opportunities
• Being able to conduct the insurance benefits and eligibility verification to assist/guide patients in understanding expected out-of-pocket costs in office, and over the phone.
• Communicating with patients regarding billing questions and insurance explanations
• Effectively explaining patient balances, insurance processing, deductible/coinsurance responsibilities, and denial outcomes
• Answering inbound billing department phone calls professionally and courteously
• Assisting patients in understanding when balances become patient responsibility after insurance adjudication
• Ensure compliance with HIPAA and other healthcare regulations
• Providing administrative support to the Billing Department as needed

Learn more about us at clinicaldermatologycenter.com

Company Description

Learn more about us at clinicaldermatologycenter.com