BILLING SPECIALIST

About the Role

The Billing Specialist, working within the Revenue Cycle Management (RCM) department, is responsible for ensuring accurate claim creation, timely submission, and effective follow-up to maximize reimbursement. This role verifies insurance information, resolves billing discrepancies, supports denial prevention efforts, and contributes directly to clean claim rates and overall revenue integrity.

Responsibilities

• Generate and submit accurate and compliant medical claims (professional and/or facility) within established timeframes.
• Verify patient demographics, insurance coverage, benefits, and eligibility prior to claim submission.
• Review, correct, and clarify billing discrepancies, coding issues, modifier usage, and payer requirements.
• Prepare and process claim adjustments, rejections, resubmissions, and appeals as needed.
• Monitor claim status through payer portals, clearinghouses, and internal systems to ensure timely resolution.
• Support denial management workflows by researching root causes and coordinating corrective actions to reduce future denials.
• Maintain up-to-date billing records, documentation, payment information, and correspondence in accordance with RCM standards.
• Communicate professionally with patients, insurance payers, providers, and internal departments to resolve billing questions.
• Assist in identifying trends related to rejections, denials, and coding concerns to improve overall revenue cycle performance.
• Perform data entry, documentation, scanning, and general administrative tasks supporting billing operations.
• Adhere strictly to HIPAA privacy requirements and safeguard all patient health information.
• Participate in training, audits, and process improvement initiatives as assigned.
• Other duties as assigned.

Qualifications

• High school diploma required; Associate degree preferred.
• 1–2 years of experience in medical billing or RCM required (multi-specialty or high-volume practice preferred).
• Familiarity with payer portals and claim submission systems strongly preferred.

Required Skills

• Strong understanding of healthcare billing processes, payer rules, and revenue cycle workflows.
• Knowledge of CPT, HCPCS, ICD-10 coding basics and common payer edits (not a coder, but able to interpret billing issues).
• Excellent communication skills with the ability to explain billing information clearly to patients and team members.
• High accuracy and attention to detail in data entry and claim review.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced RCM environment.
• Experience working with EMR/EHR systems, clearinghouses, or billing platforms.