Medical Billing Specialist

Medical Billing Specialist Department:

Business Office FLSA Status:

Non-Exempt Reports To:

Business Operations Manager Position Summary The Medical Billing Specialist is responsible for overseeing and performing the day-to-day medical billing and revenue cycle functions of the practice. This role serves as a subject matter expert in charge posting, claims management, payment posting, account resolution, and insurance follow-up while ensuring accuracy, efficiency, and exceptional service to patients and families. The Medical Billing Specialist serves as a resource to other Business Office team members and helps support departmental workflows, training, and continuous improvement initiatives. Essential Duties & Responsibilities Revenue Cycle & Billing Operations Reviews and posts all pending charges from the prior day's business. Audits charge line items for accurate CPT, ICD-10, diagnosis, and modifier usage prior to claim submission. Ensures claims are transmitted accurately and timely to the clearinghouse. Monitors claim acceptance, rejections, denials, and payment trends to identify opportunities for improvement. Manages and follows up on all outstanding claims greater than 45 days to ensure timely reimbursement. Investigates claim denials and underpayments and initiates appropriate corrective actions. Works collaboratively with insurance carriers to resolve claim issues and expedite payment. Payment Posting & Reconciliation Posts insurance and patient payments accurately and efficiently. Balances daily receipts entered into the practice management system and promptly reports discrepancies. Prepares and reconciles daily bank deposits. Assists with account adjustments, refund requests, and patient and insurance refunds as needed. Accounts Receivable & Collections Identifies collection accounts and determines appropriate next steps in accordance with practice policies and procedures. Reviews aging reports and proactively addresses outstanding balances. Assists patients with account inquiries, payment questions, insurance concerns, and billing resolutions. Leadership & Team Support Serves as a lead resource for medical billing and revenue cycle processes within the Business Office. Provides guidance, training, and support to Business Office team members as needed. Assists with process improvement initiatives designed to enhance billing accuracy, collections, and workflow efficiency. Serves as a backup for all Business Office functions and helps ensure operational continuity. Assists the Business Operations Manager with special projects and departmental initiatives. Customer Service Answers incoming Business Office phone calls professionally and courteously. Provides exceptional customer service while addressing patient billing, insurance, and account-related questions. Maintains confidentiality and professionalism in all patient and financial interactions. Minimum Requirements Required High school diploma or equivalent. Minimum 3-5 years of medical billing and revenue cycle experience, preferably in a physician practice or outpatient healthcare setting.

Demonstrated experience with:

◦ Medical claims submission and follow-up. ◦ Insurance payment posting and reconciliation. ◦ Accounts receivable management. ◦ Denial resolution and appeals. ◦ Patient account management and collections. Working knowledge of CPT, ICD-10, HCPCS, and modifier usage. Strong understanding of commercial insurance, PPO, HMO, Medicaid, and other payer types. Strong analytical, organizational, and problem-solving skills. Ability to work independently, prioritize competing responsibilities, and meet deadlines. Excellent customer service and communication skills. Preferred Lead, senior, or supervisory experience within a medical billing environment. Experience with Athenahealth or similar practice management software. Pediatric or multi-provider physician practice experience. Schedule & Benefits 36 hours per week. Eligible for medical, dental, vision, and 401(k) benefits.

Pay:

From $24.00 per hour

Benefits:

401(k) matching Dental insurance Health insurance Vision insurance

Work Location:

In person