Department: Business Office
FLSA Status: Non-Exempt
Reports To: Business Operations Manager
Position Summary
The Medical Billing Specialist is responsible for overseeing and performing the day-to-day medical billing and revenue cycle functions of the practice. This role serves as a subject matter expert in charge posting, claims management, payment posting, account resolution, and insurance follow-up while ensuring accuracy, efficiency, and exceptional service to patients and families. The Medical Billing Specialist serves as a resource to other Business Office team members and helps support departmental workflows, training, and continuous improvement initiatives.
Essential Duties & Responsibilities
Revenue Cycle & Billing Operations
- Reviews and posts all pending charges from the prior day’s business.
- Audits charge line items for accurate CPT, ICD-10, diagnosis, and modifier usage prior to claim submission.
- Ensures claims are transmitted accurately and timely to the clearinghouse.
- Monitors claim acceptance, rejections, denials, and payment trends to identify opportunities for mprovement.
- Manages and follows up on all outstanding claims greater than 45 days to ensure timely reimbursement.
- Investigates claim denials and underpayments and initiates appropriate corrective actions.
- Works collaboratively with insurance carriers to resolve claim issues and expedite payment.
Payment Posting & Reconciliation
- Posts insurance and patient payments accurately and efficiently.
- Balances daily receipts entered into the practice management system and promptly reports discrepancies.
- Prepares and reconciles daily bank deposits.
- Assists with account adjustments, refund requests, and patient and insurance refunds as needed.
Accounts Receivable & Collections
- Identifies collection accounts and determines appropriate next steps in accordance with practice policies and procedures.
- Reviews aging reports and proactively addresses outstanding balances.
- Assists patients with account inquiries, payment questions, insurance concerns, and billing resolutions.
Leadership & Team Support
- Serves as a lead resource for medical billing and revenue cycle processes within the Business Office.
- Provides guidance, training, and support to Business Office team members as needed.
- Assists with process improvement initiatives designed to enhance billing accuracy, collections, and workflow efficiency.
- Serves as a backup for all Business Office functions and helps ensure operational continuity.
- Assists the Business Operations Manager with special projects and departmental initiatives.
Customer Service
- Answers incoming Business Office phone calls professionally and courteously.
- Provides exceptional customer service while addressing patient billing, insurance, and account-related questions.
- Maintains confidentiality and professionalism in all patient and financial interactions.
Minimum Requirements
Required
- High school diploma or equivalent.
- Minimum 3-5 years of medical billing and revenue cycle experience, preferably in a physician practice or outpatient healthcare setting.
- Demonstrated experience with:
- Medical claims submission and follow-up.
- Insurance payment posting and reconciliation.
- Accounts receivable management.
- Denial resolution and appeals.
- Patient account management and collections.
- Working knowledge of CPT, ICD-10, HCPCS, and modifier usage.
- Strong understanding of commercial insurance, PPO, HMO, Medicaid, and other payer types.
- Strong analytical, organizational, and problem-solving skills.
- Ability to work independently, prioritize competing responsibilities, and meet deadlines.
- Excellent customer service and communication skills.
Preferred
- Lead, senior, or supervisory experience within a medical billing environment.
- Experience with Athenahealth or similar practice management software.
- Pediatric or multi-provider physician practice experience.
Schedule & Benefits
- 36 hours per week.
- Eligible for medical, dental, vision, and 401(k) benefits.