Medical Billing Specialist

Gebbs Healthcare Solutions Inc•East Haven, CT

12d•$19 - $24

About The Position

The Medical Billing Specialist is responsible for reviewing newly posted charges for accuracy; reconciling patient management system edits and clearinghouse rejections; managing and resolving accounts receivable for healthcare providers; and ensuring timely, accurate reimbursement from insurance payers and patients. The role involves understanding CPT coding and CMS guidelines, following up with insurance companies, interpreting Explanation of Benefits (EOBs), managing denials, and navigating patient management systems, payer systems, and clearinghouses.

Requirements

At least 2 years of experience in U.S. healthcare accounts receivable, medical billing, and/or revenue cycle operations.
Strong knowledge of commercial and government insurance, including Medicare and Medicaid.
Familiarity with CPT, ICD-10, and HCPCS codes.
Experience with clearinghouses, scrubber tools, EHR/patient management systems, and payer portals.
Ability to read and interpret EOBs/ERAs and payer guidelines.
Proficiency in reading and analyzing EOBs/ERAs and insurance denials.
Strong attention to detail and accuracy.
Excellent communication, analytical, and problem-solving skills.
Proficiency in Microsoft Excel and medical billing software.

Nice To Haves

Experience working in a medical billing company environment.
EPIC experience.
Medical billing or related certification and/or CPC certification.
Experience with medical billing across a wide spectrum of specialties, such as cardiology, radiology, primary care, and behavioral health.

Responsibilities

Enter medical charges into the billing system and review claims using scrubber tools to ensure demographics and coding are complete, accurate, and compliant with payer guidelines before submission.
Ensure charges are entered within required turnaround times.
Identify and correct charge discrepancies, including modifiers, places of service, and code sequencing.
Monitor and resolve edit and rejection queues in time to meet submission deadlines.
Track and document recurring edit and rejection trends to support training and process improvements.
Monitor and manage accounts receivable aging reports for assigned clients.
Follow up with insurance companies by phone, email, and payer portals to resolve unpaid or denied claims.
Interpret EOBs and ERAs to determine appropriate action on claims.
Reconcile denials, no-response scenarios, and clearinghouse rejections; assess trends and prioritize work based on aging, account-related situations, and payer guidelines.
Correct and resubmit denied or rejected claims as necessary.
Document follow-up activities and claim-status updates in billing software.
Communicate with payers, providers, and internal teams to resolve claim issues.
Identify denial and underpayment trends to support root cause analysis and improvement.
Work with patients regarding outstanding balances with flexibility and empathy.
Collaborate with coding, charge-entry, and patient services teams to resolve claim issues.
Ensure compliance with HIPAA and relevant federal, state, and payer-specific regulations.