Billing Specialist

Description

The Medical Billing Specialist is responsible for reviewing, preparing, and submitting accurate medical claims to insurance carriers in a timely manner. This role ensures that all charges are supported by appropriate documentation, coding, and payer requirements prior to claim submission. The Medical Biller works closely with coding, prior authorization, and clinical teams to resolve claim discrepancies, correct errors, and ensure clean claims are submitted on the first pass whenever possible. The position plays a critical role in maintaining billing accuracy, minimizing denials, and supporting efficient revenue cycle operations.

Essential Duties and Responsibilities

• Review patient encounters and charges to ensure accuracy and completeness prior to claim submission.
• Submit professional claims electronically and through payer portals in accordance with payer requirements and internal billing timelines.
• Verify that CPT, HCPCS, modifiers, and ICD-10 codes are present and supported by provider documentation prior to billing.
• Review and correct claim edits
• Work closely with coding and clinical teams to clarify documentation discrepancies impacting claim submission.
• Identify trends in documentation errors and claim edits and report findings to management.
• Ensure claims are submitted within timely filing requirements for all insurance carriers.
• Maintain patient confidentiality and comply with all HIPAA policies and organizational guidelines.
• Assist with special projects and workflow improvements as assigned.

Required Skills and Abilities

• Ability to organize workload and manage time effectively
• Ability to establish and maintain effective working relationships with providers, management, employees, and the public
• Strong computer and data entry skills
• Ability to review claims for accuracy prior to submission
• Ability to interpret payer billing guidelines and requirements
• Ability to handle a high volume of work with speed and accuracy
• Ability to identify and resolve claim errors prior to submission
• Able to multi-task and work quickly with constantly changing circumstances and priorities
• Strong attention to detail
• Problem solving and critical thinking skills

Qualifications

• High school diploma or equivalent
• Experience in a health care billing environment required
• Knowledge of medical billing processes and claim submission required
• ICD-10, CPT, and HCPCS knowledge required
• Experience working with clearinghouses and payer portals preferred
• Proficiency in MS Office
• Experience working within an Electronic Medical Record (EMR) or Practice Management system preferred

Physical Requirements

Prolonged periods of sitting and/or being stationary at a desk. Consistently uses computers and relates information via email, messaging and phone. Must communicate with others and exchange information frequently and on an on-going basis. Must be able to lift/move up to 15 lbs.

GCP is an equal opportunity employer and does not discriminate in employment on account of race, color, religion, sex, gender, pregnancy, national origin, age, marital or familial status, sexual orientation, gender identity, disability, medical condition, veteran status, genetic information, ancestry, or any other basis protected under federal, state, or local law.