Medical Billing Specialist

Job Description

Job Description

We are looking for a Medical Billing Specialist to support billing operations for a Contract position based in Providence, Rhode Island. This role focuses on accurate claim processing, insurance follow-up, and account review within a healthcare setting. The ideal candidate brings hands-on medical billing experience, strong attention to detail, and the ability to work effectively with clinical teams and payer contacts.

Responsibilities:
• Maintain accurate patient insurance details and demographic information to support clean claim submission and reduce billing delays.
• Enter charges for assigned programs in a timely manner while ensuring coding and billing data are complete and correct.
• Communicate with insurance carriers to address claim issues, clarify coverage questions, and help resolve reimbursement concerns.
• Advise program leaders and clinical staff on billing expectations, documentation needs, and payer-related procedures.
• Track high-dollar balances and unusual account activity, then escalate trends and concerns to the Billing Manager.
• Review receivables aging on a routine basis to help ensure claims are submitted and worked within payer filing deadlines.
• Research payer policies and billing rules independently to maintain compliance and improve claim accuracy.
• Use Inovalon and related billing tools to manage account activity, document follow-up, and support day-to-day revenue cycle tasks.• Prior experience in medical billing within a healthcare environment; behavioral health billing experience is preferred.
• Working knowledge of medical billing practices, claim workflows, and reimbursement processes.
• Familiarity with medical coding and the ability to interpret billing-related documentation accurately.
• Experience reviewing accounts receivable, aging reports, and denied or delayed claims.
• Strong communication skills with the ability to collaborate with clinicians, program leadership, and insurance representatives.
• High level of accuracy, organization, and follow-through when managing billing records and account activity.
• Experience using billing software; exposure to Inovalon is preferred.