Medical BIlling Specialist

We are seeking an experienced Medical Billing Specialist to join our administrative team. The ideal candidate will have a strong understanding of coding, billing, and reimbursement processes. This position is responsible for accurately submitting insurance claims, following up on accounts, and ensuring timely reimbursement for surgical services.

Billing and Coding:

• Review and verify medical charts, procedures, and patient records to ensure accurate coding for surgeries and related services.
• Prepare and submit claims to insurance companies and third-party payers using appropriate CPT, ICD-10, and HCPCS codes.
• Ensure compliance with all healthcare billing regulations, including HIPAA, CMS, and payer-specific guidelines                       

• Monitor the status of insurance claims, following up on unpaid or denied claims to ensure timely resolution.
• Work with insurance representatives to clarify discrepancies and resolve issues related to claim denials, rejections, or underpayments.
• Maintain a current understanding of insurance contracts and policies to ensure correct billing practices.

Payment Posting and Reconciliation:

• Post insurance and patient payments to accounts accurately and in a timely manner.
• Reconcile accounts to ensure payments match billed amounts and address any discrepancies.

Patient Billing:

• Generate patient statements and follow up on outstanding balances or payment arrangements.
• Address patient inquiries regarding billing issues and provide clarity on charges, insurance payments, and patient responsibility.
• Work with patients to set up payment plans as necessary.

Reporting and Documentation:

• Generate and maintain billing and payment reports for management and auditing purposes.
• Maintain detailed records of claims submissions, follow-ups, denials, and resolutions for audit purposes.

Customer Service and Communication:

• Provide excellent customer service to patients, insurance companies, and healthcare providers by responding to inquiries and addressing issues      promptly.
• Communicate effectively with surgeons, nurses, and other healthcare staff to ensure that all charges are accurately documented and coded.

Compliance and Training:

• Stay up to date with changes in healthcare billing codes, regulations, and payer policies.
• Assist with internal audits to ensure billing practices meet regulatory and compliance standards.
• Participate in ongoing education and training to enhance knowledge of billing practices and codes.
• Collaborate      with surgeons, nurses, and administrative staff to ensure accuracy of billing data

Qualifications:

• High school diploma or equivalent required; Associate’s degree or certification in medical billing and coding preferred.
• Certification in medical billing and coding (e.g., CPC, CCS) is highly preferred.
• Proven experience as a billing specialist in an ambulatory surgical center, outpatient setting, or healthcare-related field.
• In-depth knowledge of ASC billing procedures, coding (CPT, ICD-10, HCPCS), insurance verification, and healthcare billing regulations is highly preferred.
• Familiarity with electronic health record (EHR) systems and medical billing software.
• Strong attention to detail, organizational skills, and the ability to work under tight deadlines.
• Excellent verbal and written communication skills.
• Ability to work independently and as part of a team.