Medical Billing Specialist Jobs

Job Summary:

The Medical Billing Specialist is responsible for processing all third-party primary and secondary insurance claims for ancillary professional services. The incumbent in this position performs insurance billing, account follow-up, and collections on all outstanding balances.

• Contacts third party payors and patients to expedite and maximize payment of insurance medical claims.
• Resolves claims denials as they appear.
• Researches/refunds/resolves insurance credit balances.
• Participates in educational activities and attends team meetings. Assists with knowledge sharing, payor and department training, and provides support to other team members. Supports department coverage plans as directed by leadership (vacation, leave of absence, etc.).
• Identifies, analyzes, and escalates trends impacting AR reimbursement.
• Demonstrates expertise of all payors, including Medicare, Medicaid and commercial payors, and applicable department’s revenue cycle operations. Ensures protection of private health and personal information. Adheres to all HIPAA and PCIO compliance regulations.
• Documents clear, concise, and complete follow up notes in system for each account worked. Visually proofreads and monitors work output to ensure accounts are completed.
• Reviews third party payer work queues to locate accounts for billing. Resolves edits related to billing within established Epic charge review and claim edit work queues to ensure claims are billed accurately.
• Collaborates with management to reduce aging of accounts by providing verbal and written communication.
• Performs other duties as assigned.
• Remains current on collection procedures of various payors and specialty departments.
• Identifies claims processing issues and notifies leadership to avoid further delay in claims processing.
• Submits claims to the clearing house, reconciles submitted claims, identifies those that rejected, and addresses any remaining issues with submission.

• Minimum of 2 years’ billing experience required, preferably in a multi-specialty physician practice.
• High school diploma or equivalent required.
• Certified Revenue Cycle Specialist (CRCS-I) or related industry certification preferred.
• Knowledge of professional CPT and diagnosis codes preferred.