Healthcare Billing Specialist

The Healthcare Biller is responsible for accurately creating, reviewing, and submitting claims to insurance carriers and other payers in a timely manner. This position verifies patient accounts and coverage information, follows claims through the revenue cycle, and helps resolve issues that may delay payment. The Healthcare Biller also serves as a backup Payment Poster and supports accurate, compliant documentation of all billing activity.

Essential Duties and Responsibilities

• Create, review, and submit accurate electronic and paper claims to insurance carriers and other payers within established timelines.
• Confirm that claims include complete patient, provider, insurance, authorization, and charge information before submission.
• Complete patient account verifications, including confirming demographic information, insurance eligibility, benefits, coverage, and coordination of benefits, as applicable.
• Review claim edits, rejections, and payer responses; correct errors and resubmit claims promptly.
• Monitor outstanding claims and follow up with payers on unpaid, underpaid, or delayed claims.
• Document billing activity, payer communications, corrections, and follow-up actions clearly and accurately in the applicable system.
• Serve as a backup Payment Poster by accurately posting insurance and patient payments, adjustments, denials, and remittance information when needed.
• Protect patient confidentiality and perform all duties in accordance with HIPAA, payer requirements, company policies, and applicable laws and regulations.
• Perform other related duties as assigned.

Physical and Work Requirements

This position primarily involves prolonged periods of sitting and computer use, frequent keyboarding, and regular telephone communication. The employee must be able to perform the essential functions of the position with or without reasonable accommodation.

• High school diploma or equivalent required; associate degree or relevant billing certification preferred.
• One year of medical billing, healthcare revenue-cycle, claims, or related experience preferred.
• Working knowledge of medical insurance, claims submission, eligibility verification, remittance advice, and basic payment-posting processes.
• Experience using an electronic health record, practice-management system, clearinghouse, or payer portal preferred.
• Basic understanding of CPT, ICD-10-CM, and HCPCS code sets sufficient to identify and communicate potential claim issues; coding certification is not required unless otherwise specified.
• Proficiency with Microsoft Office and the ability to learn new software systems.

Knowledge, Skills, and Competencies

• High attention to detail and commitment to accuracy.
• Strong organization, time-management, and follow-through skills.
• Ability to prioritize competing deadlines and work independently while contributing to a team.
• Analytical and problem-solving skills, including the ability to research account discrepancies.
• Clear, professional written and verbal communication.
• Integrity and discretion when handling confidential patient and financial information.
• Dependability, adaptability, accountability, empathy, and teamwork.