Billing Specialist

Who We Are: Heart City Health is a premier healthcare network providing access to high-quality preventive and primary care for our community. As a Federally Qualified Health Center (FQHC), we are dedicated to delivering patient-centered, accessible care that promotes wellness and equity across Elkhart and the surrounding areas.

Position Summary: At Heart City Health, we are seeking a Claim Specialist responsible for gathering and processing the information required to complete medical claim processing across payer types. They will be responsible for documenting and entering required information in our systems. The team member will be responsible for ensuring the collection of outstanding accounts from insurance carriers, monitoring claims submissions, writing letters of appeal, reviewing, and obtaining the necessary documentation to submit claims, while also collaborating with clinical and operational teams to prevent rework and protect clean claim performance. The claim specialist serves as a key resource for identifying trends, reducing denials, and supporting organizations' reimbursement goals.


Key Responsibilities:

• Monitors delinquent accounts and assists in resolving issues to obtain payment.
• Compiles letters of appeal complete with LCD/NCD/ payer requirement citations.
• Knowledge of HCPCS codes and track payer policy changes to communicate with team.
• Interprets and utilizes medical policies and procedures.
• Monitors and work on assigned tasks in the PM system to maintain productivity metrics.
• Submit claims within established timelines and monitor acceptance through clearinghouse and payer portals.
• Determines covered medical insurance losses and overpayments.
• Analyzes insurance claims to prevent fraud.
• Resolve system edits to ensure clean claim submission.
• Investigate and resolve claim rejections, denials, and underpayments.
• Document root causes and escalate systemic issues to leadership for workflow correction.
• Contribute to clean claim rate, denial rate, and A/R performance reporting.
• Coordinate with coders, providers, and front-office teams to prevent repeated errors.

Required Qualifications & Competencies:

• High school diploma or equivalent (GED) required
• Degree or Certificate in Billing/Coding preferred
• Insurance verification experience, patient registration, or medical billing (FQHC a plus).
• Two years' experience required
• Computer knowledge required: Windows, Microsoft Office applications, and Practice Management Systems
• Prior experience in a professional office environment preferred
• Experience in an FQHC, RHC, or multi-payer outpatient environment.

Physical Demands:

• May sit and/or stand for long periods of time
• Must be able to see and hear within normal range with or without correction device(s)
• Dexterity and hand-eye coordination as normally associated with operating office equipment, computers, and telephones.

Work Environment:

Professional, fast-paced office work environment