Medical Billing Specialist

Southwest Womens Oncology Inc•Albuquerque, NM

1d•Onsite

About The Position

The Medical Billing Specialist owns the full billing cycle for a high-volume oncology and specialty practice, ensuring accurate and timely claims, effective denial resolution, strong payer relationships, and responsible patient account management. The role connects clinical care with financial performance and works closely with clinical and front office teams, third-party payers, government programs, managed care plans, the Patient Financial Advocate, and leadership. Responsibilities include claims submission and follow-up, investigating discrepancies and underpayments, preparing appeals, insurance verification and precertification, maintaining compliance with CMS, HIPAA, and payer requirements, managing patient balances and payment plans, documenting billing activity, supporting audit readiness, and identifying ways to improve revenue-cycle performance. The position calls for precision, ownership, patient-centered communication, teamwork, accountability, and an ongoing commitment to learning and improvement.

Requirements

Minimum 3 years of experience in medical billing.
In-depth understanding of third-party insurance, government payers, and physician billing and reimbursement processes.
Strong knowledge of posted charges, payments, and adjustments.
Proven experience with insurance precertification and verification processes.
Familiarity with CMS billing guidelines and compliance requirements.
Proficiency in medical billing software, credit card payment processing, and Microsoft Office Suite.
Professional, service-oriented communication skills for patient and payer interactions.

Nice To Haves

Oncology or specialty practice billing experience.
Experience working with patient advocacy programs and financial assistance workflows.
Familiarity with chemotherapy drug billing and specialty reimbursement processes.

Responsibilities

Submit clean, accurate claims to insurance carriers, government payers, and third-party administrators in a timely manner.
Follow up on delinquent and pending insurance claims to ensure timely resolution.
Investigate and resolve claim discrepancies, denials, and underpayments; prepare and submit appeals with supporting documentation.
Maintain accurate account records using knowledge of posted charges, payments, and adjustments.
Verify insurance and obtain precertification for scheduled procedures and treatments.
Ensure compliance with CMS billing guidelines and payer-specific requirements.
Maintain current knowledge of third-party insurance, government payer rules, and physician billing and reimbursement processes.
Oversee patient accounts, outstanding balances, collections workflows, and payment plan administration.
Address patient questions about billing, insurance, and payment concerns with empathy and professionalism.
Collaborate with the Patient Financial Advocate to support patients navigating complex financial situations.
Maintain adherence to HIPAA and applicable federal and state billing regulations.
Document billing activity, account updates, and payer communications accurately and completely.
Support audit readiness by maintaining organized, complete, and current account records.
Identify denial trends, billing errors, and workflow inefficiencies; recommend and implement corrective actions.
Collaborate with the billing team and leadership to optimize revenue-cycle performance.