Job Summary
The Billing Specialist is responsible for accurate and timely submission of medical claims, and follow-up with payers and patients. This role ensures compliance with HIPAA and payer regulations while supporting efficient revenue cycle operations.
Key Responsibilities
- Prepare, review, and submit clean claims to insurance payers (CMS-1500 and/or UB-04)
- Verify patient insurance eligibility and coverage
- Ensure accuracy of patient demographics, charges, and modifiers
- Submit claims electronically and track claim status
- Research claim denials and rejections
- Correct errors and resubmit claims in a timely manner
- Prepare and submit appeals with supporting documentation
- Generate and review patient statements
- Respond to patient billing inquiries professionally and clearly
- Maintain compliance with HIPAA Privacy and Security Rules
- Protect the confidentiality of all patient information
- Out of network billing preferred but not required
- Knowledge of Federal and State guidelines regarding NSA and TDI claims
