Medical Billing Specialist
Revenue Cycle Management is looking for a full-time Medical Billing Specialist to join our team. Hybrid opportunity after 90 days of in-person training (2 days from home, 3 days in office).
SUMMARY: The Medical Billing Specialist is responsible for analyzing patients records and coding the patients records based on ICD-10 and CPT codes. Additionally, ensure all charges are reflected on the patient account and communicate with inter-departments regarding any type of discrepancy for corrections.
Essential Functions
- Reviews patient accounts and supporting documentation to ensure all billable services and charges are captured accurately
- Validates diagnosis and procedure codes on accounts for billing accuracy and payer requirements; escalates discrepancies for correction
- Communicates with clinical, coding, and front-end teams to obtain or clarify missing or incomplete information
- Prepares and submits accurate electronic and paper claims to commercial insurance carriers and government payers
- Investigates and resolves claim denials and rejections, including appropriate corrections and resubmissions
- Maintains accurate and up-to-date patient account information within the electronic medical record (EMR) and billing systems
- Identifies trends or recurring issues impacting reimbursement and communicates findings to leadership
- Ensures compliance with payer guidelines, company policies, and applicable regulations
- Perform other related tasks as needed
Knowledge, Skills, and Abilities
- Knowledge of medical billing processes, including insurance verification, prior authorization, patient responsibility, and workers compensation
- Knowledge of explanation of benefits (EOBs), remittance advice, and coordination of benefits (COB) processing
- Working knowledge of medical terminology and ICD-10, CPT, and HCPCS coding systems as they relate to billing accuracy
- Knowledge of payer guidelines, including government and commercial insurance requirements, claims submission, and denial management
- Proficient in electronic billing systems and claim forms, including HCFA Form CMS-1500
- Experience with electronic medical records (EMR) and practice management systems
- Strong analytical and problem-solving skills with the ability to identify and resolve billing discrepancies
- High attention to detail and accuracy in reviewing and processing claims
- Strong organizational and time management skills with the ability to prioritize tasks effectively
- Ability to work independently with minimal supervision and adapt to changing priorities
- Effective written and verbal communication skills, including the ability to communicate professionally with internal teams and external parties
- Proficient in Microsoft Office applications, including Word, Excel, and PowerPoint
Education and Experience
- High School Diploma or GED
- Three (3) years of experience with medical billing, accounts receivable, or revenue cycle operations
- Medical billing certification in lieu of experience
Benefits
- 3 Medical Plans
- 2 Dental Plans
- 2 Vision Plans
- Employee Assistant Program
- Short- and Long-Term Disability Insurance
- Accidental Death & Dismemberment Plan
- 401(k) with a 2-year vesting
- PTO + Holidays