Medical Billing Specialist

Role Description

This is a full-time on-site role for a Medical Billing Specialist. As a Medical Billing Specialist, you will play a crucial role in ensuring the financial health of our customers. We seek individuals with a strong work ethic, excellent problem-solving skills, and a genuine passion for medical billing. Your responsibilities will include managing insurance communications, reconciling insurance EOBs and payments, maintaining patient confidentiality, managing denials, utilizing ICD-10 codes, verifying insurance information, and working with commercial and government insurance providers. Due to the nature of the healthcare industry, a high degree of professionalism and attention to detail is essential.

Responsibilities

• Function as a subject matter expert in support of other billing team members.
• Demonstrate a good understanding of payer benefits requirements, claims status, submissions of claims, insurance follow-up, payment posting, and reconciliation procedures.
• Approve or deny requested adjustments and refunds within role thresholds.
• Manage and resolve denied, adjusted, or underpaid procedures on insurance accounts to reduce Accounts Receivable.
• Prepare and submit electronic and paper claims to insurance companies.
• Collaborate with multiple clinics and providers to rectify demographic errors.
• Communicate effectively with insurance companies, adjusters, and third-party payers via phone, email, and other channels.
• Analyze insurance EOBs to ensure correct payment for all procedures.
• Identify trends and issues with various payers and propose solutions for resolution.
• Process and post insurance payments promptly.
• Submit insurance claims to payers in a timely manner, adhering to compliance regulations.
• Ensure compliance with relevant state and federal agencies.
• Ensure quality and productivity standards are met or exceeded.
• Perform other related duties as assigned.

Skills

• A minimum of 3 years’ experience as a medical biller, collector, or a similar role.
• Adapt to process and procedure evaluations and improvements, support continuous change, and willingly manage special projects in addition to normal workload and other duties as assigned.
• Adaptability to change and ability to prioritize tasks effectively in a fast-paced environment.
• Proficiency with office management tools, particularly Microsoft Office software.
• Exceptional organizational and time-management skills.
• Outstanding written and oral communication abilities.
• Detail-oriented and problem-solving mindset.
• Ability to translate and analyze data into reports.
• Excellent interpersonal and supervisory skills.
• Ability to act with discretion, tact, and professionalism in all situations.
• Ability to maintain records and produce reports.
• Extreme attention to detail.

Preferred Qualifications

• Knowledge and proficiency with the billing system of "Tebra or Kareo" is a big plus.
• Certified Professional Biller (CPB) or Certified Medical Reimbursement Specialist (CMRS) certification is a plus.