Medical Billing Specialist

Job Description

As a medical claim processor, you will be responsible for reviewing and processing medical

claims timely and accurately according to our Program. The person is well organized and can

handle multiple priorities and meet deadlines as required.

The position reports directly to the Operations Manager.

Office Hours: Monday – Thursday, 8:00am-5:00pm Friday, 8:30am-3:00pm

Essential Duties and Responsibilities:

Reviews and processes medical claims based on policy provisions and established

guidelines

Requests additional information from members as needed

Documents fully claims referred to senior staff for review and determination

Maintains company production and quality standards

Participates in training

Checking patient insurance coverage and eligibility before billing.

Handling patient inquiries about bills

Navigating and maintaining electronic health records (EHR) and billing software, posting payments to patient accounts.

Calling insurance companies for updates on claim status and to clarify billing details.

Adhering to HIPAA regulations, ensuring patient confidentiality at all times.

Staying updated on healthcare regulations, medical terminology, and coding practices.

Tracking, reviewing, and reporting on billing metrics, trends, and periodic audits to ensure compliance and accuracy.

Other Responsibilities:

Adheres to the company policies and procedures

Maintains strict confidentiality of client, company and personnel information

Demonstrates a strong commitment to the mission and values of the organization

Adheres to company attendance standards

Performs other duties as assigned

Skills Preferred:

Medical terminology, diagnostic and CPT codes.

Microsoft Office

Efficient communication

Proficiency with computers and medical billing software

Knowledge of ethical debt collection practices and insurance guidelines

Understanding of primary code classifications: ICD-10-CM, ICD-10-PCS, CPT and

HCPCS

Communication skills with patients/healthcare companies

Basic accounting and bookkeeping practices

Education Experience

Medical Billing and Coding Certification

1+ Years Experience in Medical Billing and Coding