Billing Specialist
About The Position
The Billing Specialist optimizes end-to-end financial workflows and safeguards the financial integrity of Charter Oak Health Center. Working within a Federally Qualified Health Center (FQHC) model, the role manages complex medical claims from encounter closure through final adjudication using eClinicalWorks (eCW) electronic medical record and practice management platforms. The position focuses on protecting net revenue capture, maximizing clean claim rates, accelerating cash flow, and proactively managing underpayments and denials. It works to minimize revenue leakage, reduce Days Sales Outstanding (DSO), and maintain compliance with HRSA guidelines, Medicaid and Medicare regulations, and HIPAA. The position audits and validates medical, dental, and behavioral health encounters; supports coding integrity and clearinghouse exception resolution; maintains accurate patient, insurance, and sliding fee scale data; and escalates missing documentation or encounter bottlenecks. It also manages denials and aged receivables, analyzes payment variances, monitors payer policies, prepares appeals, posts and reconciles payments, handles deposits and refunds, and assists patients and staff with billing and financial questions.
Requirements
- High school diploma or GED.
- At least 2–3 years of direct healthcare billing and revenue cycle experience in a hospital, high-volume physician practice, or FQHC.
- Proficiency in eClinicalWorks or a comparable enterprise EHR system such as Epic or NextGen.
Nice To Haves
- Associate's or Bachelor's degree in Healthcare Administration, Finance, or Accounting.
- Certified Revenue Cycle Specialist (CRCS) certification through AAHAM.
- Certified Professional Coder (CPC) certification through AAPC.
- Certified Medical Reimbursement Specialist (CMRS) certification.
Responsibilities
- Review, scrub, and validate high-volume medical, dental, and behavioral health encounters in eClinicalWorks before payer submission.
- Audit clinical charts for alignment with ICD-10-CM, CPT, and HCPCS Level II coding guidelines, including documentation of modifiers, time-based codes, and FQHC encounter triggers.
- Monitor and correct electronic front-end edits and clearinghouse rejections to support a clean claim rate target above 95%.
- Review and update patient demographic profiles, coordination of benefits, and sliding fee scale tiers in the practice management system.
- Identify open encounters with missing provider signatures, clinical charts, or documentation issues, and escalate them to providers and the Revenue Cycle Manager.
- Identify, trend, research, and appeal unpaid or rejected claims, including submitting formal redetermination requests.
- Audit outstanding insurance balances in 30-, 60-, 90-, and 120+-day aging categories and create follow-up queues to pursue overdue reimbursements.
- Compare ERAs and EOBs with FQHC PPS rate schedules to identify underpayments and unauthorized contractual adjustment variances.
- Monitor commercial, Medicaid, and Medicare coverage policies, filing limits, and regulatory changes, and adjust internal system edits as appropriate.
- Categorize and track denials using CARC and RARC codes to identify front-end and clinical documentation issues.
- Prepare and submit evidence-based appeal packets with clinical notes, proof of timely filing, and medical necessity documentation.
- Review insurance payment and contractual adjustment postings for accuracy and resolve payment discrepancies.
- Post patient credit card, check, and cash payments; make financial adjustments, transfer patient balances, and perform fee write-offs according to practice protocols.
- Reconcile daily payment postings and accounts receivable, prepare daily bank deposits, and maintain cash accountability.
- Verify credit balances and process patient refunds.
- Follow up on insurance and self-pay accounts receivable and initiate inquiries and appeals regarding questionable denials, rejections, or payment adjustments.
- Monitor accounts receivable aging reports for trends, non-payment causes, and systemic billing issues.
- Maintain current knowledge of third-party payer guidelines, billing updates, and healthcare regulations affecting claim processing.
- Respond promptly and professionally to billing inquiries from patients, insurance carriers, and staff.
- Counsel patients about high-deductible policies, coinsurance responsibilities, payment plans, and payment expectations.
- Assist front office staff with insurance verification, fee schedule inquiries, and patient balance questions.
- Handle billing-related calls and written correspondence clearly and empathetically.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
