Medical Billing, FRYE MAGNOLIA Rural Health Clinic

Position Summary

The Medical Billing Specialist is responsible for managing the billing process from charge entry through payment posting and claim resolution. This position works closely with providers, clinical staff, front office personnel, and insurance carriers to maximize reimbursement while maintaining compliance with federal, state, and payer regulations.

Essential Job Responsibilities

• Medical Billing

• Review and submit professional claims accurately and timely.
• Enter charges and verify coding accuracy.
• Process Medicare, Medicaid, commercial insurance, and self-pay claims.
• Monitor claim status and resolve claim edits.
• Correct billing errors and resubmit denied claims.
• Ensure timely filing requirements are met.
• Work insurance aging reports to reduce outstanding accounts receivable.
• Claims in accordance with Rural Health Clinic (RHC) billing regulations.
• Understand Medicare and Medicaid RHC reimbursement methodologies.
• Verify qualifying visits and billable services.
• Maintain compliance with CMS Rural Health Clinic guidelines.
• Assist with RHC compliance audits and documentation reviews.

• Insurance Verification & Authorizations

• Verify insurance eligibility and benefits.
• Review patient demographic information for accuracy.
• Obtain prior authorizations when required.
• Communicate insurance coverage issues with patients and providers.
• Resolve insurance eligibility discrepancies before claim submission.

• Accounts Receivable

• Follow up on unpaid insurance claims.
• Investigate payment denials and underpayments.
• Prepare and submit claim appeals.
• Work credit balances and payment discrepancies.
• Maintain acceptable accounts receivable aging.

• Payment Posting

• Accurately post insurance and patient payments.
• Reconcile daily payment batches.
• Process adjustments according to policy.
• Maintain accurate financial records.

• Compliance

• Maintain compliance with:
• CMS Rural Health Clinic regulations
• Medicare and Medicaid billing requirements
• HIPAA Privacy and Security Rules
• ICD-10-CM, CPT, and HCPCS coding guidelines
• Clinic policies and procedures

• Customer Service

• Aid patients with billing questions.
• Explain insurance benefits and patient financial responsibility.
• Coordinate with providers and clinical staff regarding documentation needed for billing.
• Maintain professional communication with insurance representatives.

Qualifications

• Required

• High school diploma or equivalent.
• Minimum of two years of medical billing experience.
• Knowledge of medical terminology.
• Experience with Medicare, Medicaid, and commercial insurance billing.
• Familiarity with CPT, ICD-10-CM, and HCPCS coding.
• Strong computer and data entry skills.
• Excellent organizational and communication skills.
• Ability to work independently and prioritize multiple tasks.

• PREFERRED

• Experience working in a Rural Health Clinic (RHC).
• Knowledge of RHC billing and reimbursement requirements.
• Experience with electronic health records (EHR) and practice management software.
• Experience with denial management and accounts receivable follow-up.
• Certified Professional Biller (CPB) or Certified Professional Coder (CPC) certification preferred.

Benefits

Frye Magnolia Rural Health Clinic offers a competitive benefits package, including:

• Competitive salary
• Medical, dental, and vision insurance
• Paid Time Off (PTO)
• Paid holidays
• Retail plan
• Continuing education opportunities
• Supportive work environment
• Opportunities for professional growth and advancement

Freedom Behavioral

Freedom Behavioral provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or any other characteristic protected by federal, state, or local laws.