Billing Specialist

Koya Medical, Inc.•Dallas, TX

81d•$55,000 - $60,000•Hybrid

About The Position

Koya Medical, Inc., a national medical equipment manufacturer and provider, is seeking an experienced Billing Specialist to handle claims submission and follow-up with Medicare, Medicaid, commercial insurance companies, and customers. The position is based at the company’s Dallas, Texas facility and follows a hybrid schedule requiring onsite work three days per week. It is full-time and exempt, and reports to the Billing Supervisor. The Billing Specialist submits claims, posts payments, addresses payer rejections and denials, and follows up to help ensure accurate and timely processing and payment while complying with applicable policies, regulations, and HIPAA requirements. The role uses primarily Niko Health claim submission software and Salesforce, and requires medical billing and claims-processing experience, including investigating and appealing denied claims. Experience with Medicare, Medicaid, and commercial payers is preferred. The employee must meet production and quality KPI standards, maintain regular and punctual attendance, and may be assigned other job-related duties or projects. Duties and responsibilities may change, and reasonable accommodations may be made for individuals with disabilities.

Requirements

High school diploma or equivalent.
Two years of experience with Medicare, Medicaid, and/or commercial insurance; experience in HME is highly preferred.
Comprehensive understanding of Medicare, Medicaid, and/or commercial insurance program rules as they apply to DME billing.
Experience in medical billing and claims processing, including investigating and appealing denied claims.
Ability to operate at a task and project level.
Intermediate knowledge or proficiency in Microsoft Office products and Salesforce is highly preferred.
Ability to take direction and communicate effectively with customers and employees at all organizational levels.
Ability to thrive in a fast-paced, dynamically changing organization.
Strong work ethic, attention to detail, and problem-solving ability.
Excellent oral and written communication, planning, and organizational skills.
Ability to prioritize and manage daily responsibilities effectively.

Nice To Haves

Some college education and/or a medical billing certificate.
Experience with Medicare, Medicaid, and commercial payers.
Two years of Medicare, Medicaid, and/or commercial insurance experience, particularly in HME.
Intermediate knowledge or proficiency in Microsoft Office products and Salesforce.

Responsibilities

Submit accurate and timely claims electronically or on paper to Medicare, Medicaid, and commercial insurers in accordance with company policy.
Work with payers to ensure medical claims are processed promptly and paid accurately.
Analyze and post EOB payments and denials in billing systems.
Identify the root causes of rejections and denials, help prevent their recurrence, and advise management and the appeals team when appropriate.
Route claims or balances considered uncollectible to the appropriate Financial Patient Responsibility Review or Write Off queues.
Respond to billing inquiries from patients, doctors, customers, and coworkers, providing the highest level of support possible.
Identify process-improvement opportunities and recommend solutions to improve departmental workflow.
Assist with other duties or projects as needed.
Maintain regular and punctual attendance.
Comply with company policies and procedures, HIPAA, and applicable state and federal regulations.
Meet or exceed production and quality KPI standards.