The Medical Billing Specialist is responsible for the accurate and timely billing, claim submission, payment posting, and follow-up of medical claims for Health Care Partners of South Carolina. This position ensures claims are processed in accordance with payer guidelines while supporting the organization’s revenue cycle goals. The Medical Billing Specialist works collaboratively with providers, clinical staff, insurance carriers, and patients to resolve billing issues, maximize reimbursement, and maintain compliance with federal, state, HRSA, FQHC, and organizational requirements.
- Prepare, review, and submit accurate medical claims using appropriate CPT, HCPCS, and ICD-10 coding.
- Process billing for Medicare, Medicaid, commercial insurance carriers, and self-pay patients.
- Monitor claim status and follow up on unpaid, denied, or rejected claims in a timely manner.
- Correct and resubmit claims as necessary to ensure prompt reimbursement.
- Post insurance and patient payments, adjustments, and reconcile billing transactions.
- Communicate with insurance companies regarding claim status, reimbursement, and authorization issues.
- Respond to patient billing inquiries and assist with payment arrangements when appropriate.
- Collaborate with providers and clinical staff to resolve documentation and coding issues affecting reimbursement.
- Maintain accurate billing records and patient account information within the Electronic Health Record (EHR) and practice management system.
- Assist with accounts receivable follow-up and support departmental revenue cycle goals.
- Ensure compliance with HIPAA, HRSA, FQHC requirements, payer guidelines, and organizational policies.
- Participate in staff meetings, required trainings, and quality improvement initiatives.
- Perform other duties as assigned.
- High school diploma or equivalent required.
- Minimum of two (2) years of medical billing experience required.
- Experience in a primary care, family medicine, or multispecialty healthcare setting preferred.
- Experience working in a Federally Qualified Health Center (FQHC) or community health center preferred.
- Knowledge of Medicare, Medicaid, commercial insurance, and payer reimbursement guidelines required.
- Experience using Electronic Health Record (EHR) and practice management systems preferred.
- Certified Professional Biller (CPB), Certified Professional Coder (CPC), or equivalent certification preferred.
- Bilingual (English/Spanish) preferred but not required.
- Knowledge of medical billing, insurance claims processing, accounts receivable, and payer reimbursement methodologies.
- Strong understanding of CPT, HCPCS, ICD-10, and medical billing regulations.
- Excellent organizational, analytical, and problem-solving skills with strong attention to detail.
- Strong customer service and communication skills.
- Proficiency in Microsoft Office, Electronic Health Record (EHR), and practice management systems.
- Ability to maintain confidentiality and protect patient information in accordance with HIPAA and organizational policies.
