Billing Specialist

Benefits :

Bonus based on performance

Competitive salary

Dental insurance

Health insurance

Paid time off

Training & development

Vision insurance

The Billing Specialist will be responsible for accurately preparing, submitting, and tracking claims and encounters to HMO health plans in compliance with industry regulations and plan requirements. This role plays a critical part in ensuring timely reimbursements and maintaining the financial health of the organization.

Key Responsibilities :

Prepare and submit accurate claims and encounters to HMO plans in a timely manner.

Review encounters for accuracy and completeness before submission.

Verify patient and provider information, ensuring alignment with health plan requirements.

Resolve claim rejections or denials by researching and correcting errors promptly.

Maintain detailed records of submitted claims, payments, and outstanding balances.

Communicate with HMO plans regarding billing inquiries, discrepancies, or follow-ups.

Collaborate with internal teams to ensure documentation and coding compliance.

Monitor billing cycles to meet deadlines and avoid delays in payment.

Provide regular reports on encounter submissions, claim status, and collection progress.

Stay up to date on billing regulations, HMO plan policies, and industry best practices.

Qualifications :

High school diploma or equivalent (Associate’s or Bachelor’s degree preferred).

Minimum 2 years of medical billing experience, preferably with HMO plans.

Strong knowledge of medical coding, claims submission, and encounter processes.

Proficient in medical billing software and MS Office (Excel, Word, Outlook).

Excellent attention to detail and accuracy.

Strong organizational and time management skills.

Ability to work independently and as part of a team.

Effective communication skills, both written and verbal.