Position Summary: 

The Billing Specialist is a key contributor to the Revenue Cycle and is responsible for the accurate and timely submission of clean claims to third‑party payers, whether electronically or on paper. This role manages claim creation, follow‑up, insurance correspondence, and resolution of billing inquiries to ensure prompt and accurate reimbursement.

The Billing Specialist supports process improvement efforts, assists with account statements, prepares and reviews financial reports, and participates in physician billing activities. The role ensures all payments related to patient services are recorded and reconciled promptly to maximize revenue and maintain strong financial performance.

Required Qualifications

• High school diploma or GED required.
• Minimum of 1–3 years of medical billing or related healthcare revenue cycle experience.
• Working knowledge of medical billing processes, including clean claims, edits, rejections, and denials.
• Experience interpreting insurance benefits, contract rates, revenue codes, and reimbursement methodologies.
• Familiarity with Medicare, Medicaid, commercial insurance, and managed care billing requirements.
• Proficiency with billing systems, clearinghouses, payer portals, and Microsoft Office applications.
• Strong analytical, organizational, and attention‑to‑detail skills.
• Effective written and verbal communication skills, with the ability to document accounts clearly and professionally.

Preferred Qualifications

• Vocational/technical training or associate degree in healthcare administration, business, or a related field.
• Prior experience with physician billing and cash reconciliation.
• Experience supporting denial management and insurance follow‑up functions.
• Knowledge of healthcare revenue cycle performance improvement processes.
• BLS/First Aid certification.

Key Responsibilities

• Prepare and submit accurate, timely insurance claims to all payers (primary, secondary, and tertiary) in accordance with payer guidelines.
• Review daily unbilled and claim edit reports to ensure clean claim submission, correcting errors related to authorizations, service dates, diagnoses, revenue codes, and reimbursement methods.
• Monitor electronic claim submissions and resolve rejections or errors through clearinghouses and payer portals; rebill or correct claims as needed.
• Process contractual adjustments, payment postings, transfers of responsibility, refunds, and account corrections, ensuring proper documentation.
• Respond to payer correspondence, rebill requests, and billing inquiries within established timelines.
• Perform follow‑up and denial management activities to support timely resolution and optimal reimbursement.
• Analyze accounts to ensure accurate net‑down and compliance with contract rates and payer requirements.
• Collaborate with physician billing agencies and assist with reconciliation of physician‑related cash receipts.
• Support business office functions as needed, including serving as backup for deposit posting and financial reconciliation.
• Participate in process improvement efforts and maintain clear, professional communication with internal teams and external payers.