Insurance and Billing Specialist

Shaun S Varghese MD PLLC•Houston, TX

3d•Onsite

About The Position

The Billing & Accounts Receivable Specialist is responsible for supporting the full revenue cycle for a pediatric neurology practice utilizing eClinicalWorks (ECW) and Waystar. This position focuses on timely claim submission, accounts receivable follow-up, denial management, payment posting, daily reconciliation, patient billing, and insurance collections. The ideal candidate possesses a strong knowledge of medical billing regulations, payer requirements, and revenue cycle management processes. This individual must be detail-oriented, skilled in problem-solving, and capable of working independently while collaborating with providers, front office staff, credentialing personnel, and management to maximize reimbursement and maintain clean claims.

Requirements

High school diploma or equivalent required.
Medical Billing and Coding coursework preferred.
Minimum one year of medical billing, accounts receivable, or revenue cycle experience preferred.
Experience working with electronic health records and practice management systems; eClinicalWorks experience strongly preferred.
Experience with clearinghouse systems and electronic claims submission; Waystar experience preferred.
Working knowledge of ICD-10-CM, CPT, and HCPCS coding.
Understanding of commercial insurance, Medicaid, and managed care plans.
Pediatric specialty billing experience preferred.

Nice To Haves

Medical Billing and Coding coursework
Minimum one year of medical billing, accounts receivable, or revenue cycle experience
eClinicalWorks experience
Waystar experience
Pediatric specialty billing experience

Responsibilities

Review and verify completed encounters for billing readiness.
Submit electronic claims through eClinicalWorks and Waystar in a timely manner.
Monitor claim status and correct claim edits, rejections, and clearinghouse errors.
Ensure claims meet payer-specific requirements prior to submission.
Assist with medical record and documentation attachment workflows when required by payers.
Manage assigned accounts receivable work queues and aging accounts.
Follow up on unpaid claims through payer portals, phone calls, correspondence, and online resources.
Prioritize aging balances, including claims exceeding 90, 120, and 180 days.
Investigate claim delays, medical records requests, coordination of benefits issues, and eligibility concerns.
Document all collection efforts and payer communications within ECW.
Review insurance denials and identify trends affecting reimbursement.
Prepare and submit corrected claims, reconsiderations, and appeals with supporting documentation.
Research payer policies, coding requirements, medical necessity guidelines, and billing regulations to support appeals.
Collaborate with management and providers to address recurring denial patterns.
Post insurance and patient payments accurately and timely.
Review Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
Process payment adjustments in accordance with payer contracts and practice policies.
Participate in daily reconciliation of posted payments, deposits, and bank activity.
Assist with the preparation and maintenance of daily reconciliation reports and supporting documentation.
Assist patients with billing questions and account balances.
Discuss payment options and payment arrangements consistent with practice policies.
Generate and monitor patient statements.
Communicate professionally and compassionately with families regarding financial responsibilities.
Perform patient outreach related to coordination of benefits, demographic updates, and insurance-related corrections.
Document all outreach attempts in accordance with departmental procedures.
Assist in resolving eligibility, subscriber information, and coverage discrepancies.
Identify workflow issues affecting reimbursement and recommend process improvements.
Participate in billing meetings, training, and revenue cycle initiatives.
Maintain knowledge of payer updates, regulatory changes, coding guidelines, and reimbursement trends.
Assist with cleanup of aging accounts, legacy balances, credit balances, and special projects as assigned.
Maintain accurate and complete documentation of all billing activities.
Follow HIPAA and patient confidentiality requirements.
Comply with all payer, federal, state, and organizational billing regulations.
Adhere to established department policies, standard operating procedures, and quality standards.