Pediatric Medical Biller / Revenue Cycle Specialist
In-House Position – Non-Remote
Job Summary
We are seeking an experienced, detail-oriented Pediatric Medical Biller and Revenue Cycle Specialist to join our team in an in-house, non-remote position.
The ideal candidate must have direct pediatric billing experience and be prepared to take ownership of the full revenue cycle management process. This position will work closely with the provider and office manager to ensure accurate coding, timely claim submission, effective denial management, proper payment posting, and consistent follow-up on outstanding accounts.
Proficiency with the Epic billing interface is required. The successful candidate must be able to work independently, identify billing issues, communicate concerns clearly, and implement an efficient and accurate billing workflow.
Key Responsibilities
- Manage the complete revenue cycle, including charge entry, claim submission, payment posting, denial management, appeals, collections, and account follow-up.
- Review pediatric medical records and provider documentation for coding and billing accuracy.
- Prepare and submit clean claims using appropriate CPT, ICD-10, HCPCS, and modifier coding.
- Submit and track claims for Texas Medicaid, TMHP, Medicaid managed-care organizations, and commercial insurance payers.
- Work directly within the Epic billing interface to review charges, claim status, edits, denials, payments, and outstanding balances.
- Follow up promptly on unpaid, rejected, or denied claims.
- Research denial reasons and prepare effective corrected claims and written appeals.
- Post EOBs and ERAs accurately and reconcile payments, adjustments, and patient balances.
- Monitor accounts receivable aging and identify recurring denial, coding, or payment trends.
- Develop and implement corrective actions to improve collections and reduce outstanding A/R.
- Handle prior authorizations and retroactive authorization requests when necessary.
- Communicate with providers and staff regarding documentation, coding, and billing discrepancies.
- Respond professionally to patient billing questions and account concerns.
- Maintain detailed and organized billing records.
- Prepare regular billing, collections, A/R, denial, and performance reports for management.
- Assist with payer audits, record requests, and compliance reviews.
- Maintain compliance with HIPAA, CMS requirements, payer policies, and applicable federal and state regulations.
- Stay current on pediatric coding, payer requirements, Medicaid policies, and billing regulations.
Required Qualifications
- At least 3–5 years of pediatric medical billing and revenue cycle management experience.
- Demonstrated experience managing the full RCM lifecycle independently.
- Proficiency with the Epic billing interface and Epic revenue cycle workflows.
- Strong knowledge of pediatric CPT and ICD-10 coding.
- Experience billing well-child visits, sick visits, vaccines, vaccine administration, developmental screenings, behavioral health screenings, and other common pediatric services.
- Extensive experience with Medicaid and Medicaid managed-care plans; Texas Medicaid and TMHP experience strongly preferred.
- Strong denial management, claims follow-up, and appeal-writing skills.
- Experience with EOB and ERA posting and account reconciliation.
- Ability to analyze A/R reports and identify billing and collection trends.
- Strong understanding of insurance claim processes, payer rules, and medical documentation.
- Excellent attention to detail, organization, and accuracy.
- Ability to manage multiple accounts and priorities independently.
- Professional communication skills when interacting with providers, staff, insurance representatives, and patients.
- Ability and willingness to work on-site.
Preferred Qualifications
- CPC, CPB, or equivalent billing or coding certification.
- Experience working in a high-volume pediatric practice.
- Strong Microsoft Excel and reporting skills.
- Familiarity with payer portals, including Availity, TMHP, and Medicaid MCO portals.
- Experience improving billing workflows and reducing accounts receivable.
Important Position Requirements
This is an in-house, non-remote position. Pediatric billing experience is required.
We are seeking someone who is willing and able to assume responsibility for all billing and revenue cycle functions, rather than performing only limited claim-entry or follow-up duties. The selected candidate must be comfortable managing the billing process from charge review through final account resolution.
Epic billing experience is required.
Pay: $35,000.00 - $40,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Professional development assistance
Work Location: In person
