Medical Billing Specialist

We are seeking a detail-oriented and organized Medical Billing Specialist to join our growing healthcare team. This position is responsible for managing the revenue cycle from insurance verification through claim resolution while ensuring accurate billing, timely reimbursement, and exceptional patient account management. The ideal candidate has experience with medical insurance billing, coding, claims follow-up, and authorization processes, and is comfortable working independently.

Essential Responsibilities

Insurance Verification & Benefits

• Verify patient insurance eligibility and benefits prior to appointments.
• Determine coverage, deductibles, copays, coinsurance, visit limits, and authorization requirements.
• Communicate benefit information accurately to patients and clinical staff.
• Maintain accurate insurance information within the electronic medical record (EMR).

Medical Billing & Claims Management

• Review documentation for completeness and billing accuracy.
• Apply appropriate CPT, ICD-10, and HCPCS coding based on provider documentation.
• Submit electronic insurance claims in a timely manner.
• Ensure compliance with payer-specific billing requirements.

Claims Follow-Up & Denial Management

• Monitor claim status and reimbursement timelines.
• Investigate and resolve rejected or denied claims.
• Submit corrected claims, appeals, and supporting documentation as needed.

Prior Authorizations

• Obtain prior authorizations and referrals as required by insurance plans.
• Coordinate with providers and insurance companies to ensure timely approvals.
• Track authorization status and expiration dates.

Compliance & Quality

• Maintain HIPAA compliance and patient confidentiality.
• Stay current on payer policies, coding updates, and billing regulations.
• Support continuous improvement of billing workflows and revenue cycle processes.

Qualifications

Required

• High school diploma or equivalent.
• Minimum of 2 years of medical billing experience in a healthcare setting.
• Working knowledge of CPT, ICD-10, and HCPCS coding.
• Experience with insurance benefit verification and claims submission.
• Experience managing claim denials and accounts receivable.
• Proficiency with EMR/EHR and medical billing software.
• Strong computer skills.

Preferred

• Experience with acupuncture, integrative medicine, physical medicine, or outpatient specialty practices.
• Familiarity with commercial insurance and Veterans Affairs Community Care (CITC/CCN) billing.
• Medical Billing and Coding certification (CPC, CPB, or equivalent).
• Experience with electronic clearinghouses and revenue cycle management systems.

Desired Skills

• Excellent problem-solving and analytical abilities.
• Ability to prioritize multiple tasks and meet deadlines.
• Strong patient communication skills.
• Ability to work independently while collaborating with providers and administrative staff.
• Commitment to accuracy, efficiency, and confidentiality.

Schedule

• Approximately 30 hours per week
• Monday–Friday schedule (hours may be flexible based on clinic needs)

What We Offer

• Medical, Dental & Vision Insurance
• Medical insurance reimbursement
• Paid time off
• 401K
• Opportunities for professional growth