Medical Billing Specialist

Are you an experienced Medical Billing Specialist interested in working for the premier, privately-owed women's health practice in the Greater Springfield, MA area? Would you like to join the billing department team of a successful Ob/Gyn group with an excellent provider group, strong management team, and amazing support staff? (Baystate Ob/Gyn Group, Inc.) Job Summary The Billing Specialist plays a crucial role in supporting efficient medical billing workflows and maintaining the financial integrity of BOGG.This position is responsible for accurately processing medical claims from start to finish within the electronic medical record (EMR) and practice management systems.Key duties include reviewing clinical documentation, ensuring accurate ICD-10 and CPT coding (specifically in Ob/Gyn), verifying payment postings, resolving claim denials, assisting patients and staff with billing inquiries, and ensuring compliance with healthcare billing regulations while maintaining strict confidentiality. Claims Processing & Revenue Cycle Operations Review and audit medical claims daily for submission to third-party payers. Review medical documentation to ensure accurate CPT/ICD-10 coding and documentation, with a primary focus on Ob/Gyn procedures and care. Identify missing or incomplete diagnostic and procedural codes (CPT/ICD-10). Add or modify patient demographic and insurance information in the practice management system as needed to ensure clean claim submission. Submit clean primary, secondary, and tertiary claims electronically or via paper, adhering to payer-specific requirements and timelines. Flag encounters missing documentation, provider signatures or CPT/ICD-10 coding for review by Revenue Cycle Manager. Payment Posting & Financial Reconciliation Review the posting of all insurance payments and contractual adjustments for accuracy; communicate and resolve any payment discrepancies. Process and accurately post patient credit card payments, checks, and cash transactions. Make appropriate financial adjustments, transfer patient balances, and perform fee write-offs in accordance with practice protocols. Reconcile daily payment postings and accounts receivable. Prepare and complete daily bank deposits accurately and maintain cash accountability. Process patient refunds efficiently upon verification of credit balances. Accounts Receivable & Denials Management Regularly follow up on outstanding accounts receivable balances for both insurance payers and self-pay patients. Initiate inquiries and appeals on questionable claim denials, rejections, or unexpected payment adjustments. Monitor aging accounts receivable reports to identify trends, root causes for non-payment, and systemic billing issues. Maintain up-to-date knowledge of third-party payer guidelines, billing updates, and healthcare regulations impacting claim processing. Patient Financial Counseling & Customer Service Answer inquiries promptly, courteously, and professionally from patients, insurance carriers, and staff regarding accounts and billing statements. Counsel patients regarding high-deductible policies, co-insurance responsibilities, payment plans, and expectations for payment. Assist front office staff with insurance verification, fee schedule inquiries, and patient balance clarity to support smooth check-in and checkout workflows. Manage billing-related telephone calls and written correspondence in a clear and empathetic manner. Compliance & Regulatory Responsibilities Maintain complete confidentiality of patient, employee, and practice information in strict compliance with HIPAA regulations and organizational policies. Ensure all billing and coding activities comply with local, state, and federal laws, regulations, and third-party guidelines. Complete required compliance training, annual education, and departmental training within established timeframes. Promptly report any privacy concerns, potential billing fraud, or compliance issues through appropriate administrative channels. Ensure all coding questions and/or denials are brought to the attention of the Revenue Cycle Manager or CPC. Professionalism & Teamwork Work collaboratively with providers, clinical personnel, front office staff, and administrative teams to streamline revenue cycle workflows. Provide cross-coverage and support to fellow billing team members during high-volume periods, system implementations, or staff absences. Attend required staff meetings, billing updates, and training sessions. Demonstrate accountability, flexibility, and a constructive attitude when responding to operational changes and evolving industry guidelines. Knowledge, Skills & Abilities Polished verbal and written communication skills and professional interpersonal etiquette. Expertise in medical billing, third-party payment processing, and accounts receivable management. Strong knowledge of CPT and ICD-10 coding guidelines, preferably in Obstetrics and Gynecology (Ob/Gyn). Familiarity with medical terminology, fee schedules, Explanation of Benefits (EOBs), and Remittance Advice (RAs). Proficiency with Electronic Medical Record (EMR) systems, Practice Management (PM) software, payment processing tools, and digital file management. Excellent organizational skills, high attention to detail, and strong math abilities. Ability to multitask, prioritize responsibilities, and manage time effectively in a fast-paced environment. Ability to work independently or collaboratively within a team depending on task requirements. Adaptability to learn new billing systems, payer rules, and regulations as healthcare standards evolve. QUALIFICATIONS Required Education: High school diploma or equivalent (GED). Preferred Education: Associate degree or higher in Healthcare Administration, Medical Billing and Coding, Business Administration, or related field. Required Experience: Minimum of two years of experience in medical billing, accounts receivable, or healthcare revenue cycle operations. Preferred Experience: Experience working in an Ob/Gyn practice or ambulatory specialty clinic. Hands‑on experience using EMR and Practice Management systems for claim submission and payment posting. Certified Professional Coder (CPC) or Certified Professional Biller (CPB) credential. CORE COMPETENCIES Technical Proficiency: Leverages EMR systems, PM software, coding tools, and billing databases with accuracy and speed. Attention to Detail & Math Skills: Ensures high accuracy in code selection, payment entries, ledger reconciliation, and claim auditing. Problem Solving & Critical Thinking: Identifies claim rejection trends, appeals denials effectively, and resolves balance discrepancies efficiently. Customer Focus: Provides respectful, transparent, and empathetic service when counseling patients on financial obligations. Communication: Explains complex coverage details and billing guidelines clearly to patients, coworkers, and external entities. Accountability: Takes full ownership of assigned billing workflows, aging reports, and daily reconciliations. Adaptability & Continuous Learning: Adapts seamlessly to changing payer regulations, billing coding updates, and internal practice needs. Integrity & Confidentiality: Upholds strict ethical practices and safeguards sensitive patient financial and health data. PHYSICAL REQUIREMENTS & WORK ENVIRONMENT Works in an office environment with continuous use of computer keyboard, mouse, calculator, and dual monitors. Sitting for extended periods with occasional standing, walking, bending, and stretching. Ability to communicate effectively via telephone, email, and in person. Requires visual acuity and prolonged mental concentration for auditing medical documents and analyzing detailed data. Ability to manage dynamic priorities, handle periodic workplace stress, and maintain accuracy under claim submission deadlines. Occasional driving may be required as practice needs dictate. Compensation & Benefits An excellent compensation/benefits package awaits the successful candidate! Hourly rate is commensurate with experience length, experience type, and formal certifications. Rest & Recharge: Holidays, generous PTO that increases with longevity, plus a paid day off for your birthday! Comprehensive Health: Premium Medical, Dental, and Vision insurance options. Financial Security: 401(k) retirement plan, Life Insurance, and Disability coverage. Smart Savings: Medical and Dependent Care Flexible Spending Accounts (FSA). 401(k) 401(k) matching Dental insurance Employee assistance program Flexible spending account Health insurance Life insurance Paid time off Professional development assistance Referral program Vision insurance Job Type:Full-time Pay:$23.00 - $27.00 per hour Expected hours:40.0 per week Benefits: 401(k) 401(k) matching Dental insurance Employee assistance program Flexible spending account Health insurance Life insurance Paid time off Professional development assistance Referral program Vision insurance Work Location:In person. #J-18808-Ljbffr Baystate Ob/Gyn Group, Inc.