The Revenue Cycle Billing Specialist is responsible for the accurate, timely, and compliant preparation, submission, and management of medical claims to insurance payers. This role helps optimize revenue cycle performance by ensuring services are documented appropriately, charges are captured accurately, claims are submitted promptly, and billing errors are identified and resolved proactively.
The ideal candidate demonstrates strong attention to detail, knowledge of medical billing practices, and a results-oriented approach to maximizing clean claim submissions while minimizing avoidable denials and reimbursement delays.
Department: Revenue Cycle Management (RCM)
Reports to: Revenue Cycle Manager
Location: Johnson City, TN (on-site)
Employment Classification: Full-Time | Non-Exempt
Essential Duties
- Review patient encounters to ensure charges are accurately captured and submitted.
- Verify patient demographics, insurance coverage, eligibility, and billing information.
- Review CPT, HCPCS, ICD-10-CM codes, modifiers, and payer billing requirements for accuracy, escalating coding questions as needed.
- Prepare and submit electronic and paper claims according to established timelines.
- Monitor clearinghouse submissions, claim acknowledgments, and rejections.
- Correct and resubmit rejected claims promptly.
- Ensure timely filing requirements are consistently met.
- Identify missing charges, incomplete documentation, coding discrepancies, and billing errors.
- Coordinate with providers, clinical personnel, and administrative teams to resolve documentation or charge entry issues.
- Monitor unbilled encounters and claims pending submission.
- Maintain awareness of Medicare, Medicaid, and commercial payer billing guidelines.
- Assist in identifying recurring billing issues and opportunities for process improvement.
- Collaborate with collections specialists to resolve claim defects and prevent recurring denials.
- Support the development of standardized billing workflows and quality control processes.
- Maintain accurate documentation of billing activities and claim corrections.
- Escalate systemic billing issues or payer-related concerns to leadership.
Performance Expectations
The Billing Specialist is expected to maintain consistent daily productivity, manage assigned billing queues, proactively resolve submission barriers, and ensure claims are processed accurately and efficiently. Success is measured by the quality, timeliness, and completeness of billing activities and the reduction of preventable revenue cycle delays.
Required Qualifications
- High school diploma or equivalent required; associate degree preferred.
- Minimum 2 years of medical billing or physician-practice revenue cycle experience preferred.
- Working knowledge of CPT, ICD-10-CM, HCPCS, insurance billing requirements, and medical terminology.
- Experience with electronic health record and practice management systems; Athenahealth experience preferred.
- Familiarity with Medicare, Medicaid, and commercial insurance billing.
- Proficiency with Microsoft Excel and standard office applications.
- Strong organizational, analytical, and problem-solving skills.
Preferred Qualifications
- Certified Professional Biller (CPB) or Certified Professional Coder (CPC).
- Experience in a multispecialty or multi-location physician practice.
- Familiarity with clearinghouse workflows, payer portals, and claim-editing tools.
Medical, dental, vision, PTO, 401(k), and weekends off.
Location
Tennessee, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
4 weeks ago