Medical Billing Specialist

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Medical Billing Specialist

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    Accounting & Finance
  • Title:

    Medical Billing Specialist
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SUMMARY: This large well known healthcare organization is looking for a medical billing specialist who would be  primarily responsible for coordination of insurance billing and claims processing assistance. This position requires expertise in healthcare billing, out-of-network medical coding and billing.

DUTIES: Primary duties include, but are not limited to, the following:

  • Complete weekly billing batches (uploads and response files) in Electronic Medical Record 
  • Work closely with insurance providers ( Medicare, Medicaid, Private insurance, PPO'S, HMO's, and cash clients) to properly obtain reimbursement in a timely manner.
  • Analyze and rectify claim denials; Research Integrated system, claim configuration for discrepancies.
  • Notify customers with delinquent accounts & attempt to secure payment
  • Assists the EMR Project Manager as directed to appeal, inquire and correct unpaid claims for re-submission on a daily basis when necessary.
  • Assist with monthly eligibility verification as well as supporting staff to complete annual Payor financial confirmation (PFI form) with clients.
  • Other duties as assigned.

SKILLS: Ideal candidate must by very detail oriented, and able to work independently as well as on a collaborative team. Must be able to interpret Explanation of Benefit statements (EOBs), analyze and resolve claim denials, and aid staff with out-of-network insurance claims. Knowledge of Medical Insurance programs such as MediCAID, , MediCARE HMO and Dual eligibility and mainstream benefits establishment. A working knowledge of Microsoft Office 2003 suite, MS Exchange Server  and DB (Lotus/Access/other) is required. Candidate must also demonstrate intermediate skill set in MS Excel 

QUALIFICATIONS: Bachelor’s Degree preferred. Experience in the technical field or certification may be substituted for degree. Strong preference given to candidates who have attended an accredited certificate program focused on Medical Billing. Ideal candidates will have a background in Hospital medical billing. 


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