Billing Specialist

About the role

We are seeking a highly motivated Billing Specialist to support the revenue cycle by ensuring accurate and timely billing, claims submission, payment posting, accounts receivable follow-up, and reimbursement for services provided by the organization. This position plays a critical role in maximizing revenue while maintaining compliance with FQHC, HRSA, Medicare, Medicaid, and commercial payer regulations. The Billing Specialist works collaboratively with providers, front office staff, coding personnel, and patients to ensure accurate billing, resolve claim issues, and promote exceptional customer service in support of HHM Health’s mission of providing accessible, high-quality healthcare to underserved communities.

Responsibilities

• Prepare, review, edit, and submit accurate electronic and paper claims to Medicare, Medicaid, commercial insurance, and other third-party payers in a timely manner.
• Enter facility charges, verify patient demographics, insurance eligibility, and encounter information to ensure accurate billing and reimbursement.
• Interpret Explanation of Benefits, update patient insurance information, and maintain accurate patient billing records and account documentation.
• Process patient statements, post insurance and patient payments, adjustments, refunds, contractual allowances, write-offs, and reconcile daily payment batches.
• Monitor claim status, resolve claim edits, denials, rejections, unpaid claims, and payment discrepancies, and submit corrected claims and appeals as needed.
• Manage accounts receivable by monitoring aging reports, following up with insurance carriers, and coordinating the resolution of outstanding claims and billing issues.
• Apply knowledge of FQHC billing requirements, Medicare and Medicaid reimbursement, sliding fee discount programs, UDS reporting, and grant-funded billing initiatives.
• Ensure compliance with HRSA, CMS, HIPAA, Medicare, Medicaid, and organizational billing policies, procedures, and regulatory requirements.
• Communicate with patients regarding billing inquiries, account balances, payment arrangements, financial responsibilities, and provide exceptional customer service.
• Collaborate with providers, coders, medical assistants, front office staff, and leadership to resolve billing issues, improve documentation, and optimize revenue cycle performance.
• Maintain accurate records, logs, journals, and documentation within the electronic health record (EHR) and practice management systems while supporting audits, reporting, and quality improvement initiatives.
• Analyze payer trends, recommend process improvements to reduce denials and maximize reimbursement, and perform other revenue cycle and billing responsibilities as assigned.

Requirements

• High school diploma or equivalent required; Associate’s degree in Medical Billing, Revenue Cycle, Healthcare Administration, or a related field preferred, or an equivalent combination of education and experience.
• Minimum of two (2) years of medical billing or revenue cycle experience, preferably in an FQHC, community health center, physician practice, or ambulatory care setting.
• Strong experience with Medicare, Medicaid, commercial insurance, managed care billing, and healthcare reimbursement processes.
• Working knowledge of FQHC billing regulations, sliding fee discount programs, UDS reporting, and HRSA/CMS requirements.
• Knowledge of ICD-10-CM, CPT, HCPCS coding principles (and ICD-9 familiarity where applicable), along with medical, dental, and vision billing practices.
• Proficiency with electronic health records (eClinicalWorks or similar), practice management systems, Microsoft Office Suite, billing software, clearinghouses, and payer portals.
• Strong analytical, organizational, problem-solving, and time management skills with the ability to manage multiple priorities in a fast-paced environment.
• Excellent written, verbal, interpersonal, and customer service skills with the ability to work independently and collaborate effectively with multidisciplinary teams.
• Demonstrated commitment to service excellence, patient-centered care, and providing compassionate service to culturally diverse and underserved populations while maintaining regulatory compliance and attention to detail.

Benefits

• Free vision, dental, and life insurance, plus competitive medical premiums.
• Health Savings Account.
• 403(b) retirement savings plan with dollar-for-dollar matching up to 3% and match 50% of the next 2% (contribute 5% to get 4% matched); 100% vested upon enrollment.
• Generous time off plan for full-time employees (Health and wellness + Paid time + Volunteer Days).
• Paid Holidays.
• Accidental Death & Dismemberment (ADD) plan.
• Short-term & Long-term Disability.
• Employee Assistance Programs (EAP).
• HHM CARES Fund (employee emergency relief fund).