Medical Billing Specialist
Position Summary
The Billing Specialist supports the accurate and timely submission of medical claims to Medicaid, Medicare, commercial insurance plans, and other third‑party payers. This role ensures full compliance with federal, state, and payer‑specific regulations while maintaining the highest standards of accuracy, professionalism, and confidentiality. The Billing Specialist also collaborates with the credentialing department for new and existing clinicians to support seamless revenue cycle operations.
Essential Duties & Responsibilities
Billing & Claims Management
- Support the Billing Manager with all billing functions and daily operations.
- Collaborate with the Office Manager, reception team, and leadership to expedite payment of accounts.
- Assist with claim generation, clean claim rates, and resolution of rejected or denied claims.
- Review charge capture for accuracy, including missing, late, covered, and non‑covered charges.
- Ensure all required documentation is attached to each claim prior to submission.
- Submit claims promptly and monitor acceptance across all payers.
- Review billing, collections, and medical record reports to track weekly billed, unbilled, and collected accounts.
- Identify accounts not selected for billing and escalate issues as needed.
Follow‑Up & Collections Support
- Identify underpaid accounts and notify the Office Manager or reception team for follow‑up.
- Review claims edit lists to identify recurring issues and support timely resolution.
- Maintain professional and effective communication with payers and patients.
- Assist with credentialing tasks for new and existing clinicians as needed.
- Stay current on payer requirements and ensure compliance with all updates. Team Support & Compliance.
- Serve as a resource to staff by answering questions, troubleshooting issues, and providing training when necessary.
- Maintain knowledge of client rights, organizational procedures, and Complere Credentialing LLC policies.
- Protect all client and patient information by strictly adhering to confidentiality standards.
Education
- High School Diploma or equivalent (GED) required
- Additional coursework or certification in medical billing, healthcare administration, or revenue cycle preferred.
Experience
- Minimum 2 years of medical billing experience (preferred), FQHC experience.
- Experience with Medicaid, Medicare, and commercial insurance billing.
- Familiarity with claim submission, denial management, and A/R follow‑up.
- Experience working in EHR and practice management systems.
Knowledge & Technical Skills
- Strong understanding of:
- CPT, ICD‑10, and HCPCS codes.
- Insurance billing rules and payer requirements.
- Clean claim processes and reimbursement guidelines.
- Medical terminology and basic anatomy.
- Ability to review documentation for accuracy and completeness.
- Skilled in researching payer policies and resolving claim issues.
- Proficient in navigating billing software and clearinghouses.
Core Competencies
- High attention to detail and accuracy.
- Strong analytical and problem‑solving skills.
- Ability to identify billing errors, missing charges, and underpayments.
- Excellent time‑management and organizational abilities.
- Strong written and verbal communication skills.
- Ability to work independently and collaboratively in a fast‑paced environment.
- Professional and courteous communication with payers, patients, and internal staff.
Compliance & Confidentiality
- Understanding of HIPAA regulations and patient privacy requirements.
- Commitment to maintaining confidentiality of all patients and organizational information.
- Ability to follow federal, state, and payer‑specific billing regulations.
Additional Information
- Reports directly to the Revenue Cycle Manager.
- Fully remote and hybrid positions are available. Competitive benefits and flexible schedules are offered.