Billing Specialist

Location: This position is located in office in St. Pete, Florida. This is not a remote job. The Medical Billing Specialist supports a high-volume pediatric urgent care practice with a strong Medicaid and managed Medicaid payer mix. This role is responsible for accurate coding, claim submission, and follow-up for episodic urgent care visits, procedures, and ancillary services, ensuring timely reimbursement while maintaining compliance with Medicaid and payer-specific requirements. Key Responsibilities Review urgent care provider documentation and assign accurate CPT, ICD-10, and HCPCS codes Bill high-volume pediatric urgent care services, including E/M levels, minor procedures, splinting, laceration repair, and diagnostic services Submit and manage claims primarily for Medicaid and Medicaid MCOs, with some commercial payers Apply correct modifiers for urgent care services, procedures, and multiple services rendered in a single visit Verify Medicaid eligibility, managed care enrollment, and urgent care coverage rules Identify, research, and resolve denials related to medical necessity, bundling, modifiers, frequency limits, and timely filing Prepare and submit corrected claims and appeals in accordance with state Medicaid guidelines Post payments, contractual adjustments, and reconcile ERAs/EOBs Monitor accounts receivable, track claim aging, and prioritize timely follow-up Work closely with clinical and front-office teams to resolve documentation, registration, or coding issues Qualifications Minimum 2 years of medical billing experience in urgent care, emergency, or pediatric physician practice settings Strong experience with Medicaid and managed Medicaid billing Solid understanding of urgent care E/M coding, procedure coding, and modifier usage Experience with EHR/EMR and practice management systems Ability to work accurately in a fast-paced, high-volume environment Preferred Certifications Certified Professional Biller (CPB) Certified Medical Reimbursement Specialist (CMRS) Urgent care or pediatric billing experience strongly preferred Knowledge of Medicaid urgent care policies and payer-specific edits Strong denial management and appeal skills High attention to detail with excellent time-management Clear communication with payers, providers, and operational staff Commitment to compliance, accuracy, and patient confidentiality #J-18808-Ljbffr Evening Pediatrics Inc