Medical Billing Specialist

Responsibilities

• Accurately post insurance and patient payments from EFTs, paper checks, ERAs, EOBs, and other payment documentation.
• Apply payments and adjustments to the correct patient account, date of service, claim, procedure code, and claim line.
• Record contractual adjustments, denials, deductibles, copayments, coinsurance, and patient responsibility according to payer information and practice policy.
• Review remittances to verify payment amounts, adjustment reason codes, denial codes, and patient responsibility.
• Reconcile posted payments and adjustments to the corresponding remittance and investigate unresolved differences.
• Identify and correct duplicate, missing, unapplied, unposted, or misapplied payments and incorrect patient balances.
• Review AR aging reports and work unpaid, delayed, underpaid, and denied claims through resolution.
• Contact insurance companies and use payer portals to research claim status and resolve payment discrepancies.
• Review and submit accurate claims, correct clearinghouse rejections, and prepare corrected claims, reconsiderations, and appeals.
• Verify patient demographics and insurance information, including eligibility and coordination of benefits.
• Identify missing or inconsistent authorization, coding, or documentation information and coordinate with appropriate staff.
• Maintain clear account notes documenting payer contacts, reference numbers, actions taken, and next steps.
• Assist patients and reception staff with billing questions.
• Follow HIPAA, confidentiality requirements, and established billing procedures.

Qualifications

• Prior medical billing experience with insurance AR follow-up and payment posting required.
• Experience posting insurance and patient payments and reconciling payments and adjustments to EOBs/ERAs.
• Ability to identify and resolve posting discrepancies and interpret adjustment codes, denial codes, and patient responsibility.
• Experience working aging reports, researching denials, and following unpaid or underpaid claims through resolution.
• Understanding of payer requirements, contractual adjustments, timely-filing limits, and appeal deadlines.
• Working knowledge of medical billing terminology and CPT, ICD-10-CM, and modifier concepts.
• Experience using billing or practice management software, payer portals, and clearinghouse tools.
• eClinicalWorks experience preferred.
• Strong attention to detail, numerical accuracy, organization, problem-solving, and follow-through.
• Professional communication and customer service skills.
• High school diploma or equivalent required.

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance