Billing Specialist

Heart City Health•Elkhart, IN

4h•Onsite

About The Position

At Heart City Health, we are seeking a Claim Specialist responsible for gathering and processing the information required to complete medical claim processing across payer types. They will be responsible for documenting and entering required information in our systems. The team member will be responsible for ensuring the collection of outstanding accounts from insurance carriers, monitoring claims submissions, writing letters of appeal, reviewing, and obtaining the necessary documentation to submit claims, while also collaborating with clinical and operational teams to prevent rework and protect clean claim performance. The claim specialist serves as a key resource for identifying trends, reducing denials, and supporting organizations' reimbursement goals.

Requirements

High school diploma or equivalent (GED) required
Insurance verification experience, patient registration, or medical billing
Two years’ experience required
Computer knowledge required: Windows, Microsoft Office applications, and Practice Management Systems

Nice To Haves

Degree or Certificate in Billing/Coding preferred
Prior experience in a professional office environment preferred
Experience in an FQHC, RHC, or multi‑payer outpatient environment.

Responsibilities

Monitors delinquent accounts and assists in resolving issues to obtain payment.
Compiles letters of appeal complete with LCD/NCD/ payer requirement citations.
Knowledge of HCPCS codes and track payer policy changes to communicate with team.
Interprets and utilizes medical policies and procedures.
Monitors and work on assigned tasks in the PM system to maintain productivity metrics.
Submit claims within established timelines and monitor acceptance through clearinghouse and payer portals.
Determines covered medical insurance losses and overpayments.
Analyzes insurance claims to prevent fraud.
Resolve system edits to ensure clean claim submission.
Investigate and resolve claim rejections, denials, and underpayments.
Document root causes and escalate systemic issues to leadership for workflow correction.
Contribute to clean claim rate, denial rate, and A/R performance reporting.
Coordinate with coders, providers, and front‑office teams to prevent repeated errors.