Experienced Billing Specialist

Job Title: Billing Specialist
Department: Finance
Reports To: Revenue Cycle Manager
FLSA Status: Non-exempt (hourly)
Work Schedule: Monday-Friday, 8:00 A.M. - 5:00 P.M., and occasional overtime as needed.

Company Benefits:

• Paid Holidays
• Medical, Vision, and Dental offerings for Full-Time employees
• Employer provided Life, AD&D, Short-term, and Long-term insurance
• Monthly accrual of paid time off (PTO)
• 401(k) deferral

Position Summary

We are seeking an experienced Billing Specialist to join our Revenue Cycle Management team. This position is responsible for managing the full billing lifecycle, including insurance claims processing, patient account management, denials resolution, and accounts receivable follow-up. The ideal candidate will have demonstrated expertise in healthcare billing across multiple payers and a strong track record of managing complex billing workflows in a fast-paced medical office environment.

Key Responsibilities

• Process and submit insurance claims via payer portals, ensuring accuracy and timely submission prior to claim deadlines

• Monitor claim status, follow up on pending claims, and obtain claim references or case numbers to confirm successful submission

• Manage patient billing accounts, including posting of payments and adjustments, and resolution of patient account inquiries

• Analyze and resolve insurance denials, including research of denial codes, medical policy requirements, and generation of appeals when appropriate

• Perform accounts receivable follow-up on aged balances, including insurance follow-up and patient collection efforts

• Troubleshoot billing workflow issues and coordinate with clinical staff and payers to resolve missing documentation or records

• Support pre-authorization and pre-pay processes for surgeries, imaging, and other procedures as assigned by management

• Prepare and maintain billing reports using Excel; analyze billing data to identify trends and support management decision-making

• Explain patient accounts and billing statements to patients when needed; answer patient inquiries regarding charges, balances, and payment options in a professional and courteous manner

Essential Skills

• Technical Skills: Insurance portals, EHR software, Excel, MS Office

• Problem-Solving: Ability to research and resolve complex billing issues and claim denials independently

• Communication: Clear written and verbal communication with insurance representatives, patients, and clinical staff

• Organization: Ability to manage multiple accounts and deadlines with strong time management

• Compliance: Understanding of healthcare privacy regulations (HIPAA) and billing compliance requirements

Required Qualifications

• Minimum 3 years of healthcare billing experience in a medical office or hospital billing environment

• Proficiency with multiple insurance company web portals and ability to quickly learn new systems

• Experience with an Electronic Health Record (EHR) system for billing functions

• Strong knowledge of medical billing terminology, insurance claim processing, and claims denial management

• Demonstrated accuracy and attention to detail in claim submission and financial data management

• High school diploma or GED required; associate degree or higher preferred

Preferred Qualifications

• Prior healthcare billing experience in an orthopedic, surgical, or specialty practice

• Experience with denials management, appeals process, and Claim Adjustment Reason Codes (CARCs)

• Certification in Medical Billing and Coding (AAPC or AHIMA credentials

• Experience with billing system configuration and data analysis

• Proficiency with Excel and data management tools

Physical and Work Environment

• Ability to work in an office environment for extended periods

• Frequent computer use with proficiency in typing and data entry

• Ability to work independently and as part of a team in a medical office setting