Medical Billing SpecialistPosition SummaryThe Medical Billing Specialist is responsible for the accurate and timely submission, follow-up, and resolution of medical claims to ensure maximum reimbursement and efficient cash collections. This role serves as a key contributor to the organization's revenue cycle by managing billing processes, insurance claims, payment posting, denial resolution, and accounts receivable follow-up. The ideal candidate possesses strong knowledge of healthcare billing practices, payer guidelines, and revenue cycle operations.

Key ResponsibilitiesPrepare, review, and submit medical claims to commercial insurance carriers, Medicare, Medicaid, and other third-party payers.

Verify patient insurance eligibility, benefits, and authorization requirements.

Ensure claims are coded and billed accurately according to payer guidelines and established procedures.

Monitor claim status and follow up on unpaid, denied, or underpaid claims.

Research and resolve billing discrepancies, claim rejections, and denial issues, including submitting appeals when appropriate.

Post insurance and patient payments accurately and reconcile billing records.

Manage patient account balances and assist with collection efforts when necessary.

Respond to patient, provider, and insurance company inquiries regarding billing matters.

Maintain detailed and accurate documentation of billing activity and collection efforts.

Review aging reports and prioritize accounts receivable follow-up to improve cash flow.

Support revenue cycle initiatives by identifying trends in denials, underpayments, and reimbursement delays.

Ensure compliance with HIPAA, payer regulations, and healthcare billing standards.

Key SkillsMedical BillingClaims Submission & Follow-UpPayment PostingInsurance VerificationDenial Management & AppealsAccounts Receivable Follow-UpCollectionsRevenue Cycle ManagementMedicare & Medicaid BillingHealthcare ReimbursementHIPAA ComplianceCustomer Service