Medical Billing Specialist

Southwest Womens Oncology/Optimum•Albuquerque, NM

9d•Onsite

About The Position

The Medical Billing Specialist is responsible for making the billing workflow function effectively, ensuring patients are not blindsided, claims are clean, and revenue flows smoothly, allowing the practice to focus on care. This role is crucial for preventing delayed reimbursements, patient frustration, compliance exposure, and unrecovered revenue. The specialist will approach their work with precision, ownership, and a commitment to patients and the practice. Southwest Women's Oncology (SWWO) holds billing to the same standard as clinical care, recognizing the financial experience as part of the patient experience. The company values attitude and aptitude, with credentials being secondary to personal growth and character.

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 handling 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.
Actively 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.
Apply strong knowledge of posted charges, payments, and adjustments to maintain accurate account records.
Perform insurance verification and 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, including outstanding balances, collections workflows, and payment plan administration.
Address patient inquiries regarding billing, insurance, and payment concerns with empathy and professionalism.
Collaborate with the Patient Financial Advocate to support patients navigating complex financial situations.
Maintain strict adherence to HIPAA and all applicable federal and state billing regulations.
Document all billing activity, account updates, and payer communications accurately and completely.
Support audit readiness through 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.
Raise the standard through precision, ownership, and example.