Medical Billing Specialist

We are seeking an experienced Billing Specialist to join our team. The ideal candidate will be responsible for all aspects of the billing to insurances, from claim submission to payment posting and denial management for several clients. The role requires a detail-oriented professional with a strong understanding of medical billing processes, insurance guidelines, and coding principles.

Benefits: Good salary, Paid vacations, 401K

Key Responsibilities

-Claims Processing, Submission and Revenue Optimization:

- Accurately review, prepare, and submit claims to insurance payers (Medicare, Medicaid, commercial insurance, and third-party payers, etc).

- Ensure compliance with payer requirements, CPT, ICD-10, and HCPCS coding guidelines.

- Follow up on outstanding claims and resubmit denied claims when necessary.

- Perform accounts receivable (A/R) follow-ups and work claim denials to maximize reimbursement.

- Identify and resolve billing errors or discrepancies to prevent revenue loss.

- Process patient payments and post insurance payments, including EOB (Explanation of Benefits) reconciliation.

- Investigate claim denials, determine appropriate corrections, and file appeals with insurance companies.

- Communicate with payers to resolve claim issues and expedite reimbursement.

- Patient & Client Communication:

- Assist with patient billing inquiries and provide clear explanations of account balances.

- Work closely with providers and office staff to ensure proper claim documentation.

- Compliance & Reporting:

- Maintain compliance with HIPAA, payer policies, and federal/state regulations.

- Generate and analyze billing reports to identify trends and opportunities for improvement.

- Stay updated on industry changes, coding updates, and payer policies.

Qualifications & Requirements

- Education & Certification:

- High school diploma or equivalent (required).

- Certification in medical billing and coding preferred.

Experience:

- Minimum of 2-3 years of experience in medical billing,

- Experience with Medicare, Medicaid, and commercial insurance payers.

- Knowledge of medical terminology, CPT, ICD-10, and HCPCS codes.

- Skills & Abilities:

- Proficiency in electronic health records (EHR) and medical billing software.

- Strong analytical, problem-solving, and attention-to-detail skills.

- Ability to work independently and as part of a team.

- Excellent communication and organizational skills. Both written and verbal communication must be exceptional

Bilingual in Spanish is a plus.