Medical Billing Specialist
About The Position
Join Our Thriving Pediatric Orthopaedic Group! Are you a detail-oriented insurance collector passionate about ensuring accurate billing in a fast-paced environment? We are seeking a highly motivated Billing Specialist to join our revenue cycle management team and play a vital role in bringing patient accounts to a zero balance. In this role, you will oversee the billing process for healthcare services, ensuring accurate claim submissions and full payment collection. Your responsibilities will include reviewing rejected claims, making justified adjustments, handling appeals for denied or underpaid claims, creating monthly Accounts Receivable reports, and resolving issues with provider representatives.
Requirements
- Minimum of 2 years’ experience as a medical revenue cycle
- Proven track record in AR follow-up, EDI management, coding, medical terminology, and computer skills.
- CPC or CPB certification (or willingness to obtain within 2 years - employer paid).
Nice To Haves
- Experience in insurance verification and pediatrics/orthopaedics.
- Familiarity with AthenaPractice, Encoda, or Phreesia.
- Knowledge of Florida Medicaid.
Responsibilities
- Analyze claim denials and take corrective action, including corrected claims, reconsiderations, and appeals.
- Apply accurate adjustments based on insurance guidelines and contracts.
- Manage secondary insurance and patient responsibility.
- Work closely with the team to resolve outstanding insurance payments.
- Pull insurance policies and set up system edits and scrubs to prevent future denials.
- Correspond with Insurance Verification and Front Desk to input missing data and correct registration errors.
- Communicate effectively with patients and front desk regarding balances and collect payments.
- Analyze and resolve rejected claims, ensuring accurate coding and modifiers per COSSA and payer policies.
- Research, prepare, and submit appeals for denied or underpaid claims.
- Draft detailed justification letters supported by documentation and payer policies.
- Coordinate with charge entry personnel and revenue cycle specialists to ensure accurate claim processing and resubmission.
- Work with providers to optimize appeals and validate adjustments.
Benefits
- 95% employee premium coverage for Medical (UHC), Dental (Delta)
- $20,000 life insurance policy with no payroll deductions
- 16 days of PTO and 5 days of SD/Serious Illness accrued in the first year
- Profit Sharing (Employer contributions begin after one year, with a historical rate of at least 14% annually)
- 401K & Roth 401K employee contribution plan
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
