Medical Billing Specialist

Established healthcare provider network requires a remote Medical Billing Specialist to manage our insurance claims and patient billing processes. Our organization serves thousands of patients annually across multiple medical specialties, requiring meticulous attention to billing details and insurance requirements. This position plays a crucial role in maintaining our revenue cycle while ensuring compliance with healthcare billing regulations.

Insurance Claims Management

Process and submit electronic insurance claims for various medical services and procedures. Verify patient insurance eligibility and benefits before services are rendered. Review and correct claim rejections or denials, researching reasons and resubmitting with necessary corrections. Follow up on outstanding claims with insurance companies through phone and online portals. Maintain detailed records of claim submissions, payments, and adjustments. Stay current with ICD-10, CPT, and HCPCS coding updates and requirements. Process Explanation of Benefits (EOB) documents and reconcile payments against expected reimbursements. Identify and report recurring billing issues or patterns that require process improvements.

Patient Billing and Account Management

Generate and send patient statements for balances after insurance processing. Process patient payments and set up payment plans according to organizational policies. Respond to patient billing inquiries with clear explanations of charges and insurance processing. Review patient accounts for accuracy and make necessary adjustments or write-offs. Coordinate with clinical staff to obtain missing information needed for complete claim submission. Maintain patient confidentiality while handling sensitive financial and medical information. Prepare billing reports for management showing collections, aging, and denial trends. Assist patients with understanding their insurance coverage and out-of-pocket responsibilities.

Qualifications and Experience

Previous medical billing experience with understanding of insurance claim processes and requirements. Knowledge of medical terminology, diagnosis codes, and procedure coding systems. Familiarity with healthcare compliance regulations including HIPAA billing requirements. Strong numerical aptitude and attention to detail for accurate claim processing. Experience with medical billing software and electronic health record systems. Excellent communication skills for professional interactions with insurance representatives and patients. Ability to work independently while managing multiple tasks and deadlines effectively. Commitment to maintaining accuracy in financial records and patient account information.