Billing Specialist

Analyzes, investigates, and resolves complex inpatient and outpatient medical insurance claims and billing information errors. Ensures compliance with managed care guidelines and organizational policies. Supports accurate and timely claim processing, reimbursement, and documentation across internal and external stakeholders.

Responsibilities

• Review daily billing claim listings and determine which require further analysis and action.
• Investigate incomplete or incorrect claims and resolve complex billing issues.
• Prioritize and submit claims electronically or on paper while following insurance guidelines and processing procedures.
• Research and resolve issues related to patient insurance accounts and report trends to management when appropriate.
• Analyze rejected account information and determine the cause of rejections.
• Provide input on system edits that support compliant medical insurance claim processing.
• Respond to internal requests regarding coding, billing, and processing of insurance claims.
• Communicate with internal departments, patients, payors, social service agencies, Medicare/Medicaid staff, insurers, providers, and collection agencies.
• Initiate charge and contractual allowance corrections within scope of authority.
• Research late charges and adjust patient accounts when necessary.
• Calculate write-off amounts and obtain required management approvals.
• Maintain accurate documentation in online systems and electronic files.
• Support managed care contract compliance and timely reimbursement efforts.
• Assist with special projects, analyses, audits, cross-training, and backup coverage as needed.