The Medical Billing Specialist is a key position in the revenue cycle focusing on denials. Responsibilities include managing the claims process, verifying insurance benefits, acquiring authorizations, creating timely and accurate claims, follow-ups, and correspondence with clients, providers, and insurance companies. The role ensures payments are recorded and reconciled promptly to maximize cash flow and reimbursement, assists with process improvements, and ensures compliance with departmental and regulatory policies.
Essential duties include maintaining knowledge of ICD-10 and CPT codes, medical terminology, billing, insurance reimbursement, and healthcare regulations; maintaining billing system knowledge; adhering to HIPAA guidelines; verifying and inputting demographic and authorization information; managing authorization-related files; reviewing payments for accuracy; researching and appealing denied claims; coordinating with patients, insurance companies, and co-workers; tracking insurance visit limits; and providing training and backup support for billing positions.
Qualifications include a high school diploma (medical billing and coding certificate preferred), associate degree or 5 years related experience preferred, ability to interpret documents and perform calculations, strong reasoning and confidentiality skills, preferred courses in billing and coding procedures, experience with Microsoft Office (especially Excel), and preferred experience with Rain Tree, Waystar, and PROMISe software. Candidates must possess up-to-date child abuse clearances and background checks as required.
- High school diploma required; Medical Billing and Coding Certificate preferred
- Associate degree or equivalent experience preferred
- Knowledge of ICD-10, CPT codes, medical terminology, insurance reimbursement
- Ability to read, interpret, and write routine documents and correspondence
- Ability to perform calculations and bookkeeping
- Adherence to HIPAA and confidentiality policies
- Experience with computers and medical billing software; Microsoft Office proficiency
- Up-to-date child abuse clearances and background checks
- Previous medical billing experience preferred
- Ability to manage multiple tasks with attention to detail
Location
Pennsylvania, US
Employment Type
Part-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago