Billing Specialist

Position Summary

The Billing Specialist is responsible for managing the clinic’s medical billing and accounts receivable processes to ensure claims are submitted accurately and timely, payments are posted correctly, and outstanding balances are followed up on appropriately. This position works closely with the provider, clinical staff, patients, insurance companies, and EMR billing support team to ensure accurate reimbursement and a positive patient experience. This position will start part-time and transition to full-time after training/probationary period. The billing specialist is expected to be a hybrid position with flexibility for in-office hours. Pay $20-$30/hr dependent on experience, skills, and qualifications.

Key Responsibilities

  • Verify patient insurance eligibility and benefits as needed

  • Review claims for accuracy, including patient information, diagnosis and procedure codes, modifiers, and payer requirements.

  • Monitor claim status, aging and billing reports and follow up on unpaid, denied, rejected, and underpaid claims.

  • Research and resolve billing discrepancies and insurance denials.

  • Post insurance and patient payments accurately and reconcile accounts as needed.

  • Process patient statements and assist patients with billing questions in a professional and courteous manner.

  • Maintain accurate patient accounts and update insurance and demographic information when necessary.

  • Communicate with insurance representatives regarding claim issues, payment discrepancies, authorizations, and coverage questions.

  • Coordinate with providers and clinical staff to obtain documentation or clarification needed for accurate billing.

  • Maintain confidentiality and comply with HIPAA, payer requirements, and applicable billing regulations.

  • Prepare and audit month-end billing reports, account reconciliation.

  • Stay current with changes in insurance requirements, billing practices, coding guidelines, and reimbursement policies.

Qualifications

  • High school diploma or equivalent required; medical billing, healthcare administration, or related education preferred.

  • 2+ years of medical billing or healthcare revenue-cycle experience preferred.

  • Familiarity with insurance claims, eligibility verification, denials, payment posting, and accounts receivable.

  • Working knowledge of CPT, ICD-10-CM, and HCPCS coding is preferred.

  • Experience with electronic claims submission and medical practice management/EHR systems.

  • Strong attention to detail and excellent organizational skills.

  • Strong written and verbal communication skills.

  • Ability to protect sensitive patient information and maintain strict confidentiality.

  • Ability to work independently while also collaborating effectively with a small clinic team.

  • Professional, patient-focused approach to handling billing questions and concerns.

Preferred Skills

  • Experience working in a small medical practice or outpatient clinic.

  • Familiarity with Medicare, Medicaid, and commercial insurance plans.

  • Experience working insurance denials and appeals.

  • Ability to prioritize multiple tasks and meet billing deadlines.

Please email resume to taylor@prismfamilymedicine.com