Medical Billing Specialist

Job Summary

The Medical Billing Specialist, reporting to the Billing Lead, is responsible for the full-cycle medical billing and accounts receivable process. This essential position ensures the accuracy and compliance of all claim submissions, payment postings, and dispute resolutions. The role involves managing billing data, submitting and reconciling electronic claims (837P), handling payer denials, and supporting compliance with healthcare billing regulations and customer contracts. You are an effective communicator who thrives in a fast-paced, deadline-driven environment while ensuring accurate reimbursements and efficient claim processing.

Duties and Responsibilities

• Medical Billing & Accounts Receivable : You will prepare, review, and submit medical claims through various billing portals, generating compliant invoices. This role is also responsible for posting payments, adjustments, and denials in QuickBooks, reconciling payment documents (ERA / EOB), and diligently managing the Accounts Receivable to resolve unpaid claims.
• Claim Denials & Dispute Resolution : Requires expertise in claim denials and dispute resolution. You will analyze and resolve denied / underpaid claims from payers by submitting corrected claims and appeals. This role also involves communicating with payers to fix coding and eligibility errors and recommending process improvements based on recurring denial patterns.
• Reporting & Compliance : As part of reporting and compliance duties, you will prepare monthly and quarterly billing, reconciliation, and aging reports for management and customers. You will ensure all billing practices align with payer policies, CPT and ICD-10 coding standards, HIPAA regulations, and internal accounting controls. Additionally, you will monitor contract minimums.
• Customer & Internal Communication : You communicate with customers to clarify invoice policies, formats, and payment terms. You also answer billing inquiries from clients and internal departments through chat, email, phone, and text. You work closely with other teams to resolve billing issues.
• Administrative & Team Collaboration : You participate in weekly accounting meetings and bi-monthly company-wide updates. You monitor team chat channels for billing-related issues and assist with system problem-solving. You are also responsible for completing monthly KnowBe4 security training and staying current on policy changes and best practices.

Requirements

Benefits