The Billing Specialist I is responsible for performing insurance claim processing, billing, and follow-up to ensure timely and accurate reimbursement. This role serves as the primary contact for insurance companies and other payers, researches and resolves claim issues, and supports revenue cycle efficiency by working closely with internal clinic staff and coding professionals.
- Submit and process claims accurately and efficiently in compliance with payer requirements and company policy.
- Communicate with insurance companies, patients, and other stakeholders to resolve billing inquiries and maintain account status.
- Review and reconcile credit balances, reclassify revenue, and process adjustments per transaction coding guidelines.
- Monitor and resolve claim denials and rejections, identify trends, and implement corrective actions.
- Review and correct claim filing edits based on payer requirements and EHR system alerts.
- Maintain accurate documentation of billing actions in the practice management system.
- Gather, update, and communicate billing policy changes and keep reference materials current.
- Collaborate with management, clinic staff, and coding teams to ensure proper billing and collection procedures.
- Assist patients and insurance representatives with billing-related questions while maintaining professionalism.
- Ensure compliance with HIPAA regulations and maintain confidentiality of patient financial and medical information.
Requirements & Qualifications
- Associate degree in a healthcare-related field or technical school training in medical billing and coding preferred.
- 0-2 years of experience in medical billing, insurance claims processing, or revenue cycle management required.
- Knowledge of medical billing processes, insurance claim procedures, and payer policies.
- Strong understanding of healthcare revenue cycle operations and reimbursement methodologies.
- Proficiency in EHR and practice management systems such as Athena, Cerner, or Ingenious Med.
- Ability to interpret EOBs, identify billing discrepancies, and take corrective action.
- Excellent communication and interpersonal skills.
- Strong analytical and problem-solving abilities.
- Attention to detail and ability to manage multiple tasks while meeting deadlines.
- Working knowledge of HIPAA regulations and patient confidentiality.
- CPB certification from AAPC preferred or Certified Medical Insurance Specialist (CMIS) from PMI preferred.
Location
Pennsylvania, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
1 month ago
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