Medical Billing Specialist

Responsibilities

• Prepare, review, and submit clean medical claims to commercial payers.
• Verify claim accuracy, including coding, modifiers, eligibility, EAP authorizations, and provider details.
• Maintain oversight of claim rejections and take timely corrective actions.
• Manage denial resolution: research root cause, correct and resubmit, or prepare appeals.
• Conduct proactive follow-up on outstanding A/R and aging claims.
• Support patient billing activities and inquiries when needed.
• Document all billing activities clearly and accurately in internal systems.
• Ensure compliance with HIPAA, payer regulations, and state/federal billing guidelines.
• Collaborate with credentialing, eligibility/benefits, clinical operations, and internal RCM teammates.
• Identify trends and recommend process improvements to reduce denials and rework.

Requirements

• 2+ years of professional medical billing experience.
• Strong understanding of CPT, ICD-10, and payer billing requirements.
• Experience working with EAP (Employee Assistance Program) claims and workflows.
• Experience submitting claims through clearinghouses and practice management systems.
• Demonstrated success in A/R follow-up and denial management.
• Excellent attention to detail, organization, and ability to prioritize workload.
• Strong written and verbal communication skills.
• Self-motivated, dependable, and aligned with a mission-driven organization.

Preferred

• Behavioral health billing experience.
• Telhealth and/or multi-state payer experience.
• Experience with Candid Health.
• Experience in a startup or fast-growing healthcare organization.