BILLING SPECIALIST

Billing Specialist

The Billing Specialist, working within the Revenue Cycle Management (RCM) department, is responsible for ensuring accurate claim creation, timely submission, and effective follow-up to maximize reimbursement. This role verifies insurance information, resolves billing discrepancies, supports denial prevention efforts, and contributes directly to clean claim rates and overall revenue integrity.

Essential Duties / Responsibilities:

• Generate and submit accurate and compliant medical claims (professional and/or facility) within established timeframes.
• Verify patient demographics, insurance coverage, benefits, and eligibility prior to claim submission.
• Review, correct, and clarify billing discrepancies, coding issues, modifier usage, and payer requirements.
• Prepare and process claim adjustments, rejections, resubmissions, and appeals as needed.
• Monitor claim status through payer portals, clearinghouses, and internal systems to ensure timely resolution.
• Support denial management workflows by researching root causes and coordinating corrective actions to reduce future denials.
• Maintain up-to-date billing records, documentation, payment information, and correspondence in accordance with RCM standards.
• Communicate professionally with patients, insurance payers, providers, and internal departments to resolve billing questions.
• Assist in identifying trends related to rejections, denials, and coding concerns to improve overall revenue cycle performance.
• Perform data entry, documentation, scanning, and general administrative tasks supporting billing operations.
• Adhere strictly to HIPAA privacy requirements and safeguard all patient health information.
• Participate in training, audits, and process improvement initiatives as assigned.
• Other duties as assigned.

Required Skills / Abilities:

• Strong understanding of healthcare billing processes, payer rules, and revenue cycle workflows.
• Knowledge of CPT, HCPCS, ICD-10 coding basics and common payer edits (not a coder, but able to interpret billing issues).
• Excellent communication skills with the ability to explain billing information clearly to patients and team members.
• High accuracy and attention to detail in data entry and claim review.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced RCM environment.
• Experience working with EMR/EHR systems, clearinghouses, or billing platforms.

Education and Experience:

• High school diploma required; Associate degree preferred.
• 12 years of experience in medical billing or RCM required (multi-specialty or high-volume practice preferred).
• Familiarity with payer portals and claim submission systems strongly preferred.

StrideCare is an Equal Opportunity Employer and is committed to diversity and inclusion in our workforce. We encourage applications from candidates of all backgrounds and experiences.

Requirements:

• Ability to sit for extended periods while working at a computer.
• Manual dexterity required for operating office equipment (e.g., computers, phones, fax machines).
• Ability to lift and carry up to 20 pounds occasionally.
• Visual acuity is required to perform tasks involving computer screens and paper documents.
• Ability to move around the office to access files, office machinery, and other equipment.