Medical Revenue Cycle Billing Specialist

Providence Medical Grp. • Moraine, OH

5d • Onsite

About The Position

A medical revenue cycle billing specialist manages the revenue cycle of a healthcare facility by translating clinical procedures into billable claims. They are responsible for verifying insurance coverage, submitting claims to payers, resolving denied reimbursements, and processing patient invoices to ensure the practice receives timely and accurate payments.

Requirements

• High school diploma.
• Experience navigating Electronic Health Record (EHR) platforms and computerized billing or clearinghouse systems.
• Knowledge of CPT, ICD-10, and HCPCS coding rules and application.
• Knowledge of Medicare/Medicaid and third-party billing regulations.
• Knowledge of Medical terminology.
• Skilled in verbal and written communication.
• Skilled in attention to detail and accuracy.
• Skilled in problem solving analytics.
• Ability to establish and maintain effective relationship with staff at all levels.
• Ability to handle sensitive and confidential patient information in a professional manner.
• Ability to maintain HIPAA Compliance Regulations.

Nice To Haves

• Certified professional biller a plus.
• Athenahealth experience a plus.

Responsibilities

• Confirming patient eligibility, deductible status, and obtaining prior authorizations before medical services are rendered.
• Assembling data, including standardized medical codes like ICD-10 and CPT – to generate and submit clean claims to insurance carriers.
• Recording payments received from insurance companies and patient into the billing software, if applicable.
• Investigating rejected or underpaid claims, preparing appeals, and resubmitting claims to recover lost revenues.
• Understanding explanation of benefits (EOB) and the adjudication of the claim to interpret and explain the EOB benefits during billing inquiries.
• Identifies possible problems with Electronic Data Interchange (EDI) transmissions from Athena to clearinghouse to carrier and reports problems and/or trends.
• Participate in educational activities such as insurance seminars, Athena or billing entity updates and releases.
• Any other duties assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED