Responsible for the accurate and timely billing, claim submission, payment posting, and follow-up of medical claims for Health Care Partners of South Carolina. This role supports revenue cycle operations by working with providers, clinical staff, insurance carriers, and patients to resolve billing issues, maximize reimbursement, and maintain compliance with federal, state, HRSA, FQHC, and organizational requirements.
Key responsibilities include:
- Prepare, review, and submit accurate medical claims using CPT, HCPCS, and ICD-10 coding.
- Process billing for Medicare, Medicaid, commercial insurance carriers, and self-pay patients.
- Monitor claim status and follow up on unpaid, denied, or rejected claims.
- Correct and resubmit claims to ensure prompt reimbursement.
- Post insurance and patient payments, adjustments, and reconcile billing transactions.
- Communicate with insurance companies regarding claim status, reimbursement, and authorization issues.
- Respond to patient billing inquiries and assist with payment arrangements.
- Collaborate with providers and clinical staff to resolve documentation and coding issues affecting reimbursement.
- Maintain accurate billing records and patient account information in the EHR and practice management system.
- Assist with accounts receivable follow-up and support revenue cycle goals.
- Ensure compliance with HIPAA, HRSA, FQHC requirements, payer guidelines, and organizational policies.
- Participate in staff meetings, required trainings, and quality improvement initiatives.
Requirements & Qualifications
Education and experience
- High school diploma or equivalent required.
- Minimum of 2 years of medical billing experience required.
- Experience in a primary care, family medicine, or multispecialty healthcare setting preferred.
- Experience in an FQHC or community health center preferred.
Knowledge and skills
- Knowledge of Medicare, Medicaid, commercial insurance, and payer reimbursement guidelines.
- Strong understanding of CPT, HCPCS, ICD-10, and medical billing regulations.
- Experience using EHR and practice management systems preferred.
- Certified Professional Biller (CPB), Certified Professional Coder (CPC), or equivalent certification preferred.
- Bilingual English/Spanish preferred but not required.
- Strong organizational, analytical, and problem-solving skills.
- Excellent customer service and communication skills.
- Proficiency in Microsoft Office, EHR, and practice management systems.
- Ability to maintain confidentiality and protect patient information under HIPAA.
Location
South Carolina, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago