INSURANCE BILLING SPECIALIST II, REVENUE CYCLE MEDICAL GROUP

About the role

The Insurance Billing Specialist II is an advanced individual contributor responsible for the accurate and timely billing, follow up, and resolution of professional claims for employed and contracted SGMC providers. This role serves as a senior billing resource, handling complex claims and simple denials, providing payer specific expertise, and supporting overall revenue cycle performance.

Responsibilities

• Independently manage higher complexity accounts
• Serve as a subject matter expert for assigned payers or denial categories
• Provide guidance and support to peers
• Perform all core functions of an Insurance Billing Specialist

Requirements

• High school graduate or equivalent
• Certified Patient Account Representative certification
• Two (2) or more years of professional billing experience with complex payer exposure
• Experience supporting denial management, appeals, or payer projects

Qualifications

• Advanced knowledge of professional billing and reimbursement processes
• Extensive understanding of Medicare, Medicaid (Georgia and Florida), managed care, commercial payers, and government programs
• Advanced ability to interpret and analyze EOBs and remittance advice
• Strong working knowledge of CPT 4, HCPCS, ICD 10, and professional claim (CMS 1500) requirements
• Thorough understanding of payer timely filing rules, coordination of benefits, and secondary payer guidelines
• Ability to independently research payer policies and apply findings to claim resolution
• Proficiency in Epic PB Resolute Billing and payer web portals
• Strong analytical, organizational, and problem-solving skills
• Ability to communicate effectively with patients, payers, providers, and internal departments
• Demonstrated ability to work independently with minimal supervision
• Ability to mentor peers and provide constructive guidance
• Strong attention to detail with a high level of accuracy
• Excellent customer service skills
• Knowledge of HIPAA privacy and compliance requirements

Skills

• Advanced knowledge of professional billing and reimbursement processes
• Extensive understanding of Medicare, Medicaid (Georgia and Florida), managed care, commercial payers, and government programs
• Advanced ability to interpret and analyze EOBs and remittance advice
• Strong working knowledge of CPT 4, HCPCS, ICD 10, and professional claim (CMS 1500) requirements
• Thorough understanding of payer timely filing rules, coordination of benefits, and secondary payer guidelines
• Ability to independently research payer policies and apply findings to claim resolution
• Proficiency in Epic PB Resolute Billing and payer web portals
• Strong analytical, organizational, and problem-solving skills
• Ability to communicate effectively with patients, payers, providers, and internal departments
• Demonstrated ability to work independently with minimal supervision
• Ability to mentor peers and provide constructive guidance
• Strong attention to detail with a high level of accuracy
• Excellent customer service skills
• Knowledge of HIPAA privacy and compliance requirements

Benefits

• Low Healthcare Insurance Premiums
• 401(k) with employer match
• Paid Time Off (PTO)
• Employee discounts
• Company paid life insurance
• Short-Term and Long-Term Disability
• Cancer Insurance
• Accident Insurance
• Pet Insurance
• Tuition Reimbursement
• On-the-job training and skills development
• Opportunities for growth and advancement
• Employee Assistance Program

Pay

Details about pay are not specified in the job posting.

Schedule

The schedule is Full Time, 8 HR Day Shift, 8-5.