Medical Billing Specialist

About the role

The Medical Billing Specialist is an experienced, hands-on member of the Revenue Cycle Management team responsible for supporting the Director of Revenue Cycle Management in the day-to-day billing and collections functions of the practice. This position is intended for an individual with a strong working knowledge of medical billing who can independently manage assigned accounts, identify billing issues, work denials, follow up on outstanding claims, prepare resubmissions and appeals, and assist in maximizing appropriate reimbursement from commercial and government payers. The ideal candidate will have experience working within a physician's office, outpatient medical practice, specialty practice, or medical billing company. Experience in a smaller, fast-moving healthcare environment is particularly valuable, as the position requires adaptability, organization, independent problem-solving, and direct communication with clinical and administrative team members. This role will work closely with and under the direction of the Director of Revenue Cycle Management. The Medical Billing Specialist is expected to possess greater experience and independent billing capability than an entry-level or general biller, while escalating complex reimbursement, coding, contractual, and revenue-cycle matters to the Director or appropriate senior RCM personnel.

Responsibilities

• Claims Management & Follow-Up: Review and follow up on outstanding insurance claims to facilitate timely and accurate reimbursement. Work assigned accounts receivable and identify claims requiring additional action. Investigate unpaid, underpaid, rejected, or otherwise unresolved claims. Contact insurance carriers as necessary to determine claim status and identify outstanding requirements. Correct billing errors and prepare claims for timely resubmission. Monitor previously corrected or resubmitted claims through resolution. Assist with identifying recurring billing issues and communicate trends to the Director of Revenue Cycle Management. Maintain accurate documentation of billing activity, payer communications, claim status, and follow-up actions.
• Denials & Appeals: Review insurance denials and determine the appropriate next steps for resolution. Identify denial reasons, including coding issues, authorization problems, eligibility concerns, filing limitations, medical necessity issues, documentation requests, and payer processing errors. Correct and resubmit claims when appropriate. Prepare first-level appeals and supporting documentation in accordance with payer requirements. Follow appeals through resolution and perform additional follow-up as necessary. Escalate complex, high-dollar, recurring, or unusual denials to the Director of Revenue Cycle Management. Assist the Director in identifying denial patterns that may require changes to front-end workflows, documentation, authorization processes, or billing practices.
• Collections & Accounts Receivable: Perform consistent follow-up on outstanding accounts receivable. Prioritize accounts based on aging, balance, payer requirements, filing deadlines, and other relevant factors. Work directly with commercial insurance carriers, Medicare, Medicaid, and other applicable payers to resolve outstanding balances. Research payment discrepancies, underpayments, and unexplained adjustments. Assist with recovering appropriately billable and collectible balances. Identify accounts requiring additional documentation, corrected claims, appeals, or senior-level intervention. Maintain organized and timely follow-up to prevent avoidable aging of receivables.
• Coding & Billing Knowledge: Maintain a working understanding of CPT, ICD-10-CM, modifiers, and other coding concepts necessary to accurately review and troubleshoot claims. Recognize common coding or claim-configuration issues that may contribute to denials or reduced reimbursement. Review claims for basic billing accuracy prior to submission or resubmission. Apply appropriate payer-specific billing requirements within the scope of the position. Communicate suspected coding or documentation issues to the Director of Revenue Cycle Management or appropriate clinical personnel rather than independently making unsupported coding determinations. Remain current on billing requirements and common payer changes affecting assigned responsibilities.
• Insurance & Payer Knowledge: Possess a practical working knowledge of: Commercial insurance plans; Medicare; Medicaid and Medicaid Managed Care plans; Primary and secondary insurance coordination;