Medical Billing Assistant

HealthQ•Beverly, MA

1d•Onsite

About The Position

The Medical Billing Assistant supports front-end revenue cycle operations for the health center, ensuring accurate insurance verification, prior authorization, charge review, and claim submission. This role works within the practice management tools of athenahealth to review encounters, submit claims, and respond to patient billing inquiries. The Medical Billing Assistant also serves as a key liaison with the organization’s third-party billing vendor, which manages denial resolution, payment posting, and accounts receivable. This position helps ensure claims are submitted accurately and promptly and that eligibility, authorization, and patient account issues are addressed before claims are processed. This role requires strong attention to detail, comfort working with insurance payers, and a commitment to providing patient-centered support in a reproductive health care environment.

Requirements

Minimum of 3 years of experience in medical billing or revenue cycle support.
Experience with electronic health records (EHR) and billing systems, preferably athenahealth.
Knowledge of CPT, ICD-10, and HCPCS coding basics.
Familiarity with insurance claims processes, denials, and appeals.
Knowledge of Medicaid, Medicare, and commercial insurance reimbursement policies.
Strong attention to detail and organizational skills.
Ability to manage multiple priorities and meet deadlines.
Commitment to reproductive health care, equity, and social justice.

Nice To Haves

Certification such as Certified Professional Coder (CPC) or Certified Billing and Coding Specialist (CBCS) is a plus.
Experience in sexual and reproductive health or community health.
Experience working with an outsourced or third-party billing company.
Bilingual preferred, especially Spanish.

Responsibilities

Review encounters and charges for completeness and accuracy prior to claim submission.
Ensure appropriate CPT, HCPCS, and ICD-10 codes are documented.
Submit claims through athenahealth.
Address claim edits and submission errors prior to transmission.
Review encounters in athenahealth to ensure charges, modifiers, and documentation are complete prior to claim submission.
Monitor claim status and work queues within the EHR/practice management system.
Identify and resolve claim edits, rejections, and denials in collaboration with the third-party billing company.
Submit corrected claims and assist with appeals when necessary.
Track and follow up on unpaid or delayed claims.
Serve as the primary liaison between the clinic and the external billing company.
Communicate claim issues, coding questions, and documentation needs to the billing vendor.
Review vendor reports related to claim submission, denial trends, and revenue cycle performance.
Escalate unresolved billing issues to leadership when necessary.
Review encounter documentation to ensure accurate CPT, HCPCS, and ICD-10 coding.
Flag potential coding discrepancies and work with clinical staff to correct them.
Assist in maintaining billing guidelines specific to reproductive and sexual health services.
Respond to patient billing inquiries and assist with understanding statements and insurance coverage.
Support correction of insurance information when claims are rejected due to eligibility or demographic issues.
Coordinate with front desk teams to resolve patient account discrepancies.
Verify patient insurance coverage and eligibility prior to services.
Review payer requirements and confirm coverage details including copays, deductibles, and prior authorization requirements.
Ensure patient demographic and insurance information is accurate in athenahealth.
Monitor eligibility work queues and resolve coverage issues before services are billed.
Obtain prior authorizations for services when required by insurance plans.
Submit clinical documentation to payers as needed.
Track authorization status and ensure approvals are documented in the patient record.
Coordinate with clinical staff and scheduling teams to ensure services requiring authorization are approved in advance.
Run basic billing and claim reports within the practice management system.
Monitor denial trends and flag recurring issues.
Support internal audits of billing practices and documentation.
Maintain compliance with payer requirements and federal/state regulations.
Protect patient confidentiality in accordance with the Health Insurance Portability and Accountability Act.
Follow organizational policies related to reproductive health confidentiality and billing.
Perform other duties as assigned.