Medical Biller

## Description

**Job Title:** **Billing Specialist (Revised)**

**Job Summary****:** The Billing Specialist is responsible for preparing, submitting, and following up on claims to ensure accurate and timely reimbursement from insurance companies, government programs, and patients. This role plays a critical part in the financial cycle of healthcare delivery by managing the billing process from claim creation to payment resolution.

**Job Responsibilities/Tasks:**

• Keys charge information into entry program and produces billing.
• Assists in the processing of insurance claims including Medicare, HMO and Commercial claims
• Follow up on unpaid claims within standard billing cycle time frame.
• Resolve billing issues and resubmit denied or rejected claims.
• Work closely with patients to explain charges, set up payment plans, and collect outstanding balances.
• Verify insurance benefits and eligibility as needed.
• Stay updated on payer regulations, coding guidelines, and billing best practices.
• Collaborate with clinical documentation specialist, front desk, communication center and clinical staff to resolve discrepancies and improve claim accuracy.

## Qualifications
The jobholder must demonstrate current competencies applicable to the job position.
**Required Skills/Abilities:**

• Strong attention to detail and organizational skills.
• Knowledge of insurance guidelines including Medicare, Medicaid, and commercial carriers.
• Excellent communication and customer service skills.
• Ability to work independently and handle multiple tasks.
• **Education:**
• High school diploma or equivalent required.
• Certificate or coursework in medical billing, healthcare administration, or a related field preferred.
• **Experience:**
• Minimum of 3+ years of medical billing experience preferred.
• Familiarity with CPT, ICD-10, and HCPCS coding systems.
• Experience with electronic health records (EHR) and billing software.
• **Work Environment****:**Billing Department Area. Exposure to communicable diseases and other conditions related to clinic setting. Work may be stressful due to a busy office.

**Mental/Physical Requirements****:**Ability to work in a fast-paced environment. Ability to sit for extended periods of time. Ability to respond professionally and calmly in all situations. Ability to handle interruptions. Ability to maintain a clean, organized, friendly work environment. Punctual and flexible with schedule and duties as needs arise. Ability to work closely with a cohesive team spirit with a positive attitude.