Medical Billing Specialist

Premier Medical Resources•Houston, TX

8d•Hybrid

About The Position

Revenue Cycle Management is looking for a full-time Medical Billing Specialist to join our team! This is a hybrid opportunity after 90 days of in-person training (2 days from home, 3 days in office). The Medical Billing Specialist is responsible for analyzing patient’s records and coding the patient’s records based on ICD-10 and CPT codes. Additionally, ensure all charges are reflected on the patient account and communicate with inter-departments regarding any type of discrepancy for corrections.

Requirements

Knowledge of medical billing processes, including insurance verification, prior authorization, patient responsibility, and workers’ compensation
Knowledge of explanation of benefits (EOBs), remittance advice, and coordination of benefits (COB) processing
Working knowledge of medical terminology and ICD-10, CPT, and HCPCS coding systems as they relate to billing accuracy
Knowledge of payer guidelines, including government and commercial insurance requirements, claims submission, and denial management
Proficient in electronic billing systems and claim forms, including HCFA Form CMS-1500
Experience with electronic medical records (EMR) and practice management systems
Strong analytical and problem-solving skills with the ability to identify and resolve billing discrepancies
High attention to detail and accuracy in reviewing and processing claims
Strong organizational and time management skills with the ability to prioritize tasks effectively
Ability to work independently with minimal supervision and adapt to changing priorities
Effective written and verbal communication skills, including the ability to communicate professionally with internal teams and external parties
Proficient in Microsoft Office applications, including Word, Excel, and PowerPoint
High School Diploma or GED
Three (3) years of experience with medical billing, accounts receivable, or revenue cycle operations
Medical billing certification in lieu of experience

Responsibilities

Reviews patient accounts and supporting documentation to ensure all billable services and charges are captured accurately
Validates diagnosis and procedure codes on accounts for billing accuracy and payer requirements; escalates discrepancies for correction
Communicates with clinical, coding, and front-end teams to obtain or clarify missing or incomplete information
Prepares and submits accurate electronic and paper claims to commercial insurance carriers and government payers
Investigates and resolves claim denials and rejections, including appropriate corrections and resubmissions
Maintains accurate and up-to-date patient account information within the electronic medical record (EMR) and billing systems
Identifies trends or recurring issues impacting reimbursement and communicates findings to leadership
Ensures compliance with payer guidelines, company policies, and applicable regulations
Perform other related tasks as needed