Medical Biller and Claims Specialist

Job Description:

We are seeking a detail-oriented and experienced Medical Biller and Claims Specialist with expertise in handling appeals to join our dynamic healthcare team. The ideal candidate will have a thorough understanding of the medical billing process, claims management, and the appeals process to ensure the efficient handling of claims and maximization of revenue.

Key Responsibilities:

• Claims Management:

  • Process and submit insurance claims accurately and in a timely manner.
  • Monitor and follow up on outstanding claims to ensure prompt resolution.
  • Analyze and resolve billing issues and discrepancies with insurance companies and patients.
  • Ensure claims are compliant with insurance regulations and guidelines.

• Medical Billing:

  • Prepare, review, and transmit patient bills and insurance claims.
  • Verify patient insurance coverage and eligibility.
  • Collaborate with healthcare providers and administrative staff to gather necessary information for billing.

• Appeals and Denials:

  • Investigate and manage claim denials and underpayments.
  • Prepare and submit appeals to insurance companies with appropriate documentation.
  • Track appeal status and follow up to ensure timely resolution.
  • Communicate effectively with insurance representatives to resolve complex billing issues.

• Documentation and Reporting:

  • Maintain accurate and up-to-date patient billing records.
  • Generate reports on billing activities, claim status, and appeal outcomes.
  • Assist in maintaining compliance with HIPAA and other regulatory requirements.

• Customer Service:

  • Address patient inquiries regarding billing and insurance claims.
  • Provide clear explanations of charges and insurance benefits to patients.
  • Offer assistance and support to patients experiencing billing difficulties.

Qualifications:

• Education and Experience:

  • High school diploma or equivalent; Associate’s degree in healthcare administration or related field preferred.
  • Minimum of 3 years of experience in medical billing and claims management.
  • Proven experience in handling insurance appeals and denials.

• Skills and Competencies:

  • In-depth knowledge of medical billing procedures, ICD-10, CPT, and HCPCS coding.
  • Familiarity with electronic medical records (EMR) systems and medical billing software.
  • Strong analytical and problem-solving skills.
  • Excellent communication and interpersonal skills.
  • Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
  • Attention to detail and accuracy in processing claims and billing information.

• Certifications:

  • Certified Professional Biller (CPB) or Certified Professional Coder (CPC) preferred.

Benefits:

• Competitive salary and performance-based incentives.
• Comprehensive health, dental, and vision insurance.
• Retirement savings plan with employer match.
• Paid time off and holidays.
• Opportunities for professional development and continuing education.