The Medical Billing Specialist supports the University Health Center Business Services Department and reports to the Coding and Compliance Manager. This role is responsible for the accurate and timely preparation, review, correction, and submission of medical, vision, and CAPS claims in accordance with Medicare guidelines, as well as processing insurance remittances.
The position also monitors outstanding claims, addresses delays and denials, maintains current medical terminology knowledge, and provides customer support by managing phone inquiries, processing payments, and advising students on insurance benefits and account balances.
Key responsibilities
- Review charge tickets and SOAP notes to ensure claims are prepared accurately.
- Submit and process electronic claims through a third-party clearinghouse.
- Prepare and mail HCFA-1500 forms when claims cannot be submitted electronically.
- Review clearinghouse reports for rejected claims and implement corrective actions.
- Post insurance payments and reconcile remittances and EOBs.
- Monitor unpaid and aging claims, including claims over 90 days old.
- Submit appeals for timely filing denials and provide supporting documentation.
- Provide customer service support for students, patients, insurance carriers, and department staff.
- Ensure accurate CPT, HCPCS, and ICD-10 coding support and communication with providers and leadership.
Minimum qualifications
- High school diploma or equivalent.
- 5 years of related experience.
Preferred qualifications
- At least 5 years of experience in a healthcare environment with direct experience in financial counseling, insurance billing, and follow-up.
- Knowledge of CPT, HCPCS, and ICD-10 terminology and coding concepts.
- Certified Professional Coder (CPC) certification preferred.
- Certified Professional Medical Auditor (CPMA) certification preferred.
- Associate's or bachelor's degree in English, Business Administration, or a related field preferred.
- 3 years of experience in a multispecialty practice or hospital setting preferred.
Skills and abilities
- Strong customer service, verbal communication, and interpersonal skills.
- Proficiency with Microsoft Office.
- Basic math skills and strong attention to detail.
- Ability to manage multiple tasks accurately.
- Understanding of insurance payers and reimbursement methodologies.
- Experience using EMR and practice management systems.
- Ability to communicate professionally with cross-functional teams.
- Willingness to obtain CPC certification if not already held.
Location
Georgia, US
Employment Type
Full-time
Experience Level
Senior
Salary Range
$53,000 - $57,000
Remote work allowed
No
Posted
1 month ago