Company: EngageMED
Department: Revenue Cycle
Reports To: Revenue Cycle Manager
Position Type: Full-Time
The Billing Specialist plays a critical role in EngageMED’s centralized revenue cycle ecosystem. Responsible for ensuring the financial health of our partner clinics, this position manages the end-to-end processing of professional medical claims. The ideal candidate will ensure clean claim submission, manage complex insurance edits, process accounts receivable, and systematically resolve claim denials to maximize proper reimbursement for our healthcare providers.
Claim Submission & Scrubbing: Review, validate, and electronically submit professional medical claims (HCFA-1500) to Medicare, Medicaid, and commercial insurance payers. Ensure all demographic, insurance eligibility, and authorization details match perfectly.
Denial & Rejection Management: Monitor clearinghouse rejections and systematic payer denials. Research root causes, make necessary corrections, and file timely appeals or corrected claims to secure accurate reimbursement.
Accounts Receivable (A/R) Follow-Up: Actively work aged accounts receivable work queues. Identify trends in delinquent insurance balances and proactively contact payers to resolve outstanding claims within timely filing limits.
Payment & Adjustment Posting: Accurately post insurance payments, contractual adjustments, and patient liabilities from Electronic Remittance Advices (ERAs) and manual Explanation of Benefits (EOBs) when required.
Compliance & Quality Assurance: Maintain absolute compliance with HIPAA regulations, Medicare/Medicaid guidelines, and individual payer billing rules. Review documentation for completeness and accuracy prior to final balance processing.
Provider & Clinic Liaison: Maintain open communication with practice receptionists, financial counselors, and clinic managers to resolve front-end charge entry errors, missing authorizations, or coding inquiries.
Experience: Minimum of 2–3 years of direct experience in physician/ambulatory medical billing or healthcare revenue cycle management.
Payer Fluency: Solid understanding of commercial insurance guidelines, Medicare, Arkansas Medicaid, and managed care contract structures.
Technical Proficiency: Proven experience navigating advanced Practice Management (PM) systems, Electronic Health Records (EHR), and clearinghouse platforms (experience with platforms like Paycom for workflow management or Zoom AI documentation tools is a plus).
Industry Knowledge: Competency in medical terminology, alongside an understanding of how CPT, ICD-10, and HCPCS codes impact claim adjudication and reimbursement.
Attributes: Exceptional attention to detail, strong problem-solving skills for handling difficult claim edits, and the ability to hit performance quotas in a high-volume, deadline-driven environment.
