The Billing Specialist is responsible for processing and managing all aspects of patient billing, ensuring accurate and timely submission of claims to insurance companies and other payers. This position involves verifying patient information, reviewing coding, and ensuring compliance with billing regulations. The Billing Specialist will work closely with patients, insurance providers, and the internal healthcare team to resolve any billing issues, discrepancies, or denied claims, and will assist in the collection of outstanding payments. This role plays a key part in maintaining the financial health of the organization while ensuring a positive patient experience through clear communication and efficient billing practices.

Responsibilities: 

• Process Patient Billing: Accurately prepare, review, and submit patient claims to insurance companies, government agencies, and other payers in a timely manner.
• Verify Patient Information: Confirm patient demographic and insurance details to ensure accurate billing and coding, addressing any discrepancies as needed.
• Review and Code Medical Records: Ensure that all procedures and diagnoses are correctly coded according to established coding guidelines (CPT, ICD-10, HCPCS) and regulatory requirements.
• Handle Insurance Claims and Follow-ups: Monitor the status of insurance claims, follow up on unpaid claims, and resolve any discrepancies or denials by communicating with insurance companies or patients.
• Billing Discrepancy Resolution: Investigate and resolve billing discrepancies or patient complaints, working collaboratively with healthcare providers, insurance companies, and patients.
• Process Adjustments and Payments: Record adjustments, payments, and credits accurately, ensuring that all payments are posted correctly to patient accounts.
• Assist with Insurance Appeals: Prepare and submit appeals for denied or underpaid claims, following up as necessary to ensure a resolution.
• Maintain Accurate Billing Records: Keep thorough and accurate records of all billing activities, including claims, payments, adjustments, and communications with patients and insurance providers.
• Provide Customer Service: Address patient inquiries related to billing, explaining charges, insurance benefits, and payment options clearly and professionally.
• Collaborate with Healthcare Providers: Work closely with physicians, clinical staff, and administrators to ensure that billing codes are accurate and compliant with regulations.
• Stay Updated on Billing Regulations: Keep current with changes in billing codes, insurance requirements, and healthcare regulations to ensure continued compliance.
• Assist with Billing Reports: Help prepare and review regular billing reports, highlighting outstanding claims and payments due.
• Maintain Confidentiality: Ensure all patient and billing information is kept confidential in compliance with HIPAA and other privacy regulations.

Education/Experience:

• High school diploma or equivalent required; associate degree in Health Information Management, Medical Billing and Coding, or a related field preferred.
• Certification in medical billing or coding (e.g., CBCS, CPC, or CCS) is highly preferred.
• Minimum of 1-3 years of experience in medical billing or a related healthcare finance field, with a strong understanding of insurance claims and medical coding.
• Experience with Electronic Medical Records (EMR) systems and billing software is preferred.
• Familiarity with healthcare insurance policies, payer guidelines, and billing codes (CPT, ICD-10, HCPCS) required.
• Previous experience in handling insurance claims, submitting appeals, and following up on unpaid claims is preferred.
• Experience working with Medicare, Medicaid, and commercial insurance payers.

PanCare provides a comprehensive benefits package to include medical, dental and vision insurance. In addition, to health coverage, we offer 14 paid holidays and 3 weeks of paid vacation per year. Employees are also eligible to participate in our 403(b) plan with a 6% employer match and 3% base employer contribution.