The Billing Specialist I is responsible for performing insurance claim processing, billing, and follow-up to ensure timely and accurate reimbursement. This position serves as the primary contact for insurance companies and other payers, researching and resolving claim issues while maintaining compliance with billing regulations and organizational policies. The role works closely with internal teams, including clinic staff and coding professionals, to optimize billing operations and support revenue cycle efficiency.
This position's primary responsibility will be managing the incoming call queue and helping patients resolve their billing issues and inquiries.
Responsibilities include:
- Submitting and processing claims accurately and efficiently while following payer requirements and company policy.
- Communicating with insurance companies, patients, and other stakeholders to resolve billing inquiries and maintain account status.
- Reviewing and reconciling credit balances, reclassifying revenue, and processing adjustments per transaction coding guidelines.
- Monitoring and resolving claim denials and rejections, identifying trends, and implementing corrective actions.
- Reviewing and correcting claim filing edits based on payer requirements and EHR system alerts.
- Maintaining accurate documentation of all billing actions in the practice management system.
- Gathering, updating, and communicating billing policy changes and maintaining current reference materials.
- Collaborating with management, clinic staff, and coding teams to ensure proper billing and collection procedures.
- Assisting patients and insurance representatives with billing-related questions while maintaining professionalism.
- Ensuring compliance with HIPAA regulations and maintaining confidentiality of patient financial and medical information.
- Performing other duties as assigned.
- 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 electronic health records (EHR) and practice management systems such as Athena, Cerner, or Ingenious Med.
- Ability to interpret explanation of benefits (EOBs), identify billing discrepancies, and take corrective action.
- Excellent communication and interpersonal skills for interacting with patients, providers, and payers professionally.
- Strong analytical and problem-solving abilities to research and resolve billing issues.
- Attention to detail and ability to manage multiple tasks while meeting deadlines.
- Working knowledge of HIPAA regulations and patient confidentiality standards.
- 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