Medical Billing and Claims Specialist

Salary :

$17 - 21 hourly

Company : Pediatric Cardiology Consultants Of South Texas

Job Type : Full Time

Live Oak , Tx 78233

Job Description - Medical Billing and Claims Specialist

Benefits:

Bonus based on performance

Opportunity for advancement

Paid time off

Location: Pediatric Cardiology Consultants of South Texas (PCCST)

Job Summary:
The Billing and claims Specialist will play a critical role in managing the administrative and financial aspects of patient visits. The ideal candidate will provide excellent customer service, manage patient check-in/check-out, prior authorizations and handle billing tasks. This role also requires a detail-oriented individual who can manage patient accounts, verify insurance, and ensure the timely processing of claims and payments.

Key Responsibilities:

Front Desk Duties:
- Greet patients warmly and ensure a positive and professional experience.
- Manage patient check-in and check-out processes efficiently.
- Schedule patient appointments and follow-ups based on physician availability and patient needs.
- Maintain the reception area, keeping it clean, organized, and welcoming.

Patient Information & Account Management:
- Update and maintain patient demographics by collecting personal and financial information.
- Verify insurance coverage and confirm eligibility prior to patient appointments.
- Explain insurance coverage to patients, including out-of-pocket costs, co-pays, and deductibles.
- Collect outstanding balances, co-pays, deductibles, and previous balances as needed.

Billing & Insurance Processing:
- Manage billing processes and send claims to insurance companies using EMR.
- Handle prior authorizations and ensure all required documentation is submitted accurately.
- Communicate with insurance payers to ensure timely processing of claims and resolution of issues.
- Post charges, collections, and payments into the computer system and close daily batches.
- Monitor and follow up on unpaid claims, denials, or payment discrepancies to ensure timely reimbursement.
- Provide patients with detailed explanations of their bills, including procedures not covered by insurance.

General Administrative Duties:
- Answer incoming phone calls, manage emails, and respond to patient inquiries regarding appointments, billing, or general clinic information.
- Assist in coordinating care with physicians, MAs, nurses, and other clinic staff.
- Ensure all patient documentation is completed accurately and filed appropriately.
- Participate in daily, weekly, or monthly meetings to review clinic operations, billing, and patient satisfaction metrics.

Qualifications:

High school diploma or equivalent; additional education in healthcare administration or billing is a plus.

Experience in a medical front office role

Experience with Athena EMR is a plus

Proficiency with billing, and claims management.

Strong understanding of insurance verification, prior authorizations, and claims processing.

Excellent communication and interpersonal skills with a patient-centric approach.

Strong organizational skills and attention to detail.

Ability to handle confidential information with professionalism.

Job Type: Full-time

Schedule:

8 hour shifts

Monday to Friday

Education:

High school diploma or higher

Compensation: $17.00 - $21.00 per hour

About Us

Pediatric Cardiology Consultants of South Texas is the home of San Antonio's premier center for a child's heart. We utilize current research and innovative technology to provide our patients with the most thorough care possible. We are a specialty practice focused on providing excellent comprehensive care of congenital and acquired heart conditions.

We know that visiting a pediatric cardiologist in San Antonio for the first time can be stressful. Our goal is to provide quality care while helping our patients and families understand the evaluation process as well as their plan of care. We look forward to working with patients, families, primary care providers, and other specialists in bringing excellent, affordable care to our patients in the Greater San Antonio Area.

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Medical Billing and Claims Specialist

Job Description - Medical Billing and Claims Specialist

About Us

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