Billing Claims Specialist

Overview
We are seeking a dynamic and detail-oriented Billing Claims Specialist to join our healthcare administration team. In this vital role, you will be responsible for managing the end-to-end process of medical billing and claims submission, ensuring accuracy and timeliness.

Your expertise will help facilitate smooth reimbursement workflows, support patient accounts, and uphold compliance with industry standards. If you thrive in a fast-paced environment and are passionate about optimizing revenue cycle processes, this opportunity is perfect for you!

Responsibilities:

• Prepare, review, and submit accurate insurance claims for services rendered in a timely manner.


• Verify client insurance coverage, eligibility, and authorization requirements prior to claim submission.


• Monitor and manage accounts receivable (A/R), ensuring timely follow-up on unpaid or denied claims.


• Investigate and resolve claim denials, rejections, and payment discrepancies.


• Submit corrected claims and appeals with appropriate supporting documentation.


• Ensure all billing practices comply with payor guidelines, Medicaid requirements, and company policies.


• Maintain detailed and accurate records of billing activity, communications, and claim status updates.


• Collaborate with clinical and administrative staff to ensure accurate service documentation and coding.


• Review documentation for completeness and compliance prior to billing submission.


• Post payments, adjustments, and reconcile accounts as needed.


• Identify trends in denials or billing issues and escalate concerns to leadership.


• Maintain confidentiality of all clients’ financial and health information in accordance with HIPAA regulations.


• Assist with internal and external audits as required.


• Stay current on changes to billing regulations, payer policies, and coding requirements.


• Maintain documentation on account management, including but not limited to updating status on claims, meetings and/or correspondence with customers regarding balances, and complete actions by customers on payments.


• Escalate issues to management on customer inquiries or requests and follow through to conclusion with both management and customers.


• Perform other duties and responsibilities as assigned.

Requirements

• Proven experience in medical billing, claims processing, or related healthcare administrative roles.


• Strong knowledge of medical terminology, medical records management, and coding systems such as CPT codes, ICD-10 codes, and insurance billing procedures.


• Familiarity with EMR/EHR systems used for billing and documentation purposes.


• Excellent understanding of insurance processes including pre-authorizations, claim adjudication, denials management, and appeals.


• Ability to interpret complex medical records accurately for proper coding and billing procedures.


• Exceptional organizational skills with keen attention to detail to ensure error-free submissions.


• Effective communication skills for liaising with insurance companies, healthcare providers, and patients.

Join us as a Billing Claims Specialist to make a meaningful impact on our healthcare delivery by ensuring accurate billing practices that support our mission of providing exceptional patient care!

Benefits:

• Dental insurance


• Health insurance


• Life insurance


• Paid time off


• Tuition reimbursement


• Vision insurance

Work Location: In person