Billing Specialist Jobs

About The Position

Requirements

• Associate degree in Medical Billing, Accounts Receivable, or a related field preferred.
• At least 2 years of direct medical billing, accounts receivable, or coding experience.
• Working knowledge of medical accounts receivable, insurance and patient collections, claim rejections and denials, appeals, and related billing guidelines and policies.
• Knowledge of CPT, ICD-10, and HCPCS coding.
• Familiarity with medical insurance terminology and third-party payer reimbursement policies and procedures, including reimbursement reductions and fee schedule calculations and comparisons.
• Strong knowledge of anatomy, physiology, and medical terminology.
• Strong analytical and problem-solving skills, including the ability to identify root causes.
• Effective, accurate, and concise verbal and written communication skills.
• Ability to work independently and collaboratively as part of a team.
• Strong attention to detail, prioritization, and multitasking skills in a fast-paced environment.
• Strong customer service orientation and mathematical skills.
• Proficiency in Excel and general computer systems and software.
• Strong typing and 10-key speed and accuracy; minimum typing speed of 45 WPM.
• Ability to establish and monitor performance and productivity standards.
• Highly process-oriented and detail-focused.
• Empathy and discretion when discussing sensitive financial and family-building matters.
• Ability to handle past-due balances firmly, professionally, and confidently.
• Dependable, reliable, goal-oriented team player with a positive attitude who can also work independently.
• Ability to troubleshoot and resolve ongoing problems.
• Ability to handle stressful situations while maintaining professionalism and composure.
• Ability to build strong working relationships with patients, management, physicians, and internal teams.

Nice To Haves

• CPC certification preferred.
• Experience in a medical office practice setting is ideal.
• Fertility billing experience is preferred but not required.

Responsibilities

• Review outstanding claims, determine next steps, and contact insurance companies for status updates.
• Research and resolve accounts receivable problems and disputed or delinquent balances with patients and insurers, including misapplied payments, direct deposits, and overpayments.
• Request claim reprocessing or prepare and submit corrected claims when needed.
• Research claim rejections and denials, including using payer websites to identify rejection reasons.
• Report on outstanding insurance and patient accounts receivable over 45 days and document collection efforts.
• Review prior collection efforts monthly to confirm payment was received.
• Initiate appropriate collection actions on delinquent accounts through calls and correspondence with insurers and patients.
• Contact patients about balances after insurance processing; send statements, reminders, and final notices on schedule.
• Set up and monitor patient payment plans and auto-pay enrollments according to clinic policy.
• Accurately and promptly post patient payments made by credit card, ACH, check, or cash.
• Answer patient billing inquiries, explain how claims were processed, and provide requested documentation such as EOBs and patient ledgers.
• Update demographic and payer information obtained from patients.
• Research insurance and patient refund requests, complete paperwork, and prepare refund requests for management approval.
• Process credits, adjustments, and write-offs according to approval guidelines.
• Escalate seriously delinquent patient accounts to management, including possible referral to third-party collections, in accordance with clinic policy and applicable law.
• Document changes in insurance, billing systems, and clearinghouses to maintain an accurate audit trail.
• Post insurance payments within two business days and ensure all payments are posted for month-end close.
• Register with insurance carriers online to obtain claim and eligibility information.
• Generate and mail claims.
• Work with team members, providers, and management on appeals and denials from insurance payors.
• Inform management of insurance changes or trends that could affect claim submission and processing.
• Assign and verify diagnosis and procedure codes using ICD, HCPCS, and CPT systems, ensuring accuracy and correct sequencing under applicable regulations.
• Follow up with providers about insufficient or unclear documentation and communicate with clinical staff regarding documentation.
• Maintain compliance with medical coding policies, HIPAA, PCI standards, and billing and collection regulations, including FDCPA and state law.
• Support management on special projects and prepare requested reports.
• Perform other duties as assigned.