Billing Specialist - Pediatrics - Oak Grove

Community Health Systems Professional Services Corporation•Hattiesburg, MS

About The Position

The Billing Specialist I performs insurance claim processing, billing, and follow-up to support timely and accurate reimbursement. The role is the primary contact for insurance companies and other payers, researching and resolving claim issues while complying with billing regulations and organizational policies. The specialist submits and processes claims, responds to billing inquiries, reviews account balances and adjustments, addresses denials and rejections, corrects claim filing edits, and documents billing actions in the practice management system. The position also maintains current billing policy references, collaborates with management, clinic staff, and coding teams, and assists patients and insurance representatives with billing questions. It requires compliance with HIPAA and organizational policies, as well as regular and reliable attendance.

Requirements

0–2 years of experience in medical billing, insurance claims processing, or revenue cycle management.
Knowledge of medical billing processes, insurance claim procedures, and payer policies.
Strong understanding of healthcare revenue cycle operations and reimbursement methodologies.
Proficiency in electronic health records and practice management systems.
Ability to interpret explanations of benefits, identify billing discrepancies, and take corrective action.
Excellent communication and interpersonal skills for professional interactions with patients, providers, and payers.
Strong analytical and problem-solving abilities to research and resolve billing issues.
Attention to detail and ability to manage multiple tasks while meeting deadlines.
Working knowledge of HIPAA regulations and patient confidentiality requirements.
Must be authorized to work in the United States for an employer; immigration sponsorship is not available now or in the future.

Nice To Haves

CPB—Certified Medical Biller issued by AAPC.
Certified Medical Insurance Specialist (CMIS) issued by PMI.

Responsibilities

Submit and process claims accurately and efficiently in compliance with payer requirements and company policies.
Communicate with insurance companies, patients, and other stakeholders to resolve billing inquiries and maintain account status.
Review and reconcile credit balances, reclassify revenue, and process adjustments according to transaction coding guidelines.
Monitor and resolve claim denials and rejections, identify trends, and implement corrective actions.
Review and correct claim filing edits based on payer requirements and electronic health record system alerts.
Maintain accurate documentation of billing actions in the practice management system.
Gather, update, and communicate billing policy changes and ensure current reference materials are accessible.
Collaborate with management, clinic staff, and coding teams to support appropriate billing and collection procedures.
Assist patients and insurance representatives with billing-related questions professionally.
Comply with HIPAA regulations and protect confidential patient financial and medical information.
Perform other duties as assigned.
Maintain regular and reliable attendance and comply with all policies and standards.