Medical Billing Specialist - Women's Health

Inception Family Career•Houston, TX

16h•Remote

About The Position

The Medical Billing Specialist is responsible for timely, accurate submission of insurance claims; reviewing and updating denied claims for resubmission; and performing reconciliations to support timely billing for services provided. The role collaborates with patients, revenue cycle counterparts and work units, clinical staff, and insurance providers to improve billing efficiency and reduce claim denials. This position is fully remote. The specialist verifies patient demographic and insurance information and benefits, obtains clinical documentation for insurance review and prior authorization, records authorization references, and updates the EMR and other systems for claims and self-pay charges. The role prepares electronic claims, monitors claim acceptance and denials, reconciles transactions with schedules, resolves credit balances, prepares statements for outstanding patient balances, and performs daily charge capture and reconciliation. The specialist works with clinic and revenue cycle leadership and the Coding Team to ensure charges are accurate and appropriate to services rendered. Further responsibilities may be described during the interview process.

Requirements

High school diploma or equivalent required; an associate degree is preferred.
1–2 years of medical billing experience in a women's clinic or physician practice setting required.
Knowledge of CPT code sets and requirements, including modifiers, CPT bundling and unbundling, diagnosis assignment, Evaluation and Management codes, lab codes, and ASC HCPC code sets.
Familiarity with claim edits and clearinghouse functionality.
Familiarity with medical billing platforms used in clinic and physician practice settings.

Nice To Haves

Associate degree preferred.
1–2 years of medical billing experience related to a lab and ASC setting preferred.

Responsibilities

Review patient demographic and insurance information and confirm benefit details with insurance providers for clinic services.
Obtain medical documentation from clinicians for insurance review and prior authorization of treatment.
Document authorization reference numbers in the EMR and/or other systems.
Update and maintain the EMR and/or other systems using physician or clinic documentation to create medical claims and post self-pay charges.
Prepare electronic claim files for submission.
Monitor accepted and denied claims and update claims for resubmission as needed.
Compare transaction reports with daily schedules to ensure timely monthly billing for services provided.
Resolve credit balances and prepare related paperwork, and prepare statements for outstanding patient balances.
Perform daily charge capture, including entering patient charges into the eIVF EMR platform.
Reconcile charges against the schedule for all patients seen each day.
Ensure charges are appropriate to services rendered, working with Clinic leadership, RCM Leadership, and the Coding Team.

Benefits

Medical, dental, and vision plans for full-time employees.
Complimentary basic life insurance.
Employee Assistance Program and work-life resources.
Long-term disability insurance.
Fertility benefits, adoption assistance, and surrogacy support.
Paid maternity, paternity, and partner leave.
18 days of annual PTO and 11 paid holidays, including one floating holiday.
401(k) plan with company match and full vesting after two years.
Company-funded Lifestyle Spending Account.
Employer HSA contributions for eligible employees.
Employee Referral Program.
Continuing education reimbursement and dedicated time off for professional development.
Optional Accident, Critical Illness, Hospital Indemnity, and Pet Insurance coverage.