Medical Billing Specialist
Position Type: Full-time
Department: Patient Financial Services
Position Summary
We are seeking an experienced Medical Billing Specialist to join our team. The ideal candidate will have extensive knowledge of medical billing processes, insurance regulations, and patient collections. This role is essential to ensuring accurate and timely processing of medical claims and optimizing our revenue collection.
Required Qualifications
Experience:
- Minimum 2 years of experience in hospital or professional medical billing
- Proven experience with HCFA 1500 form completion and submission
- Demonstrated ability to work rejections, overpayments, denials, and aging reports
- Experience ensuring timely follow-up on all outstanding claims
Insurance Knowledge:
- Working knowledge of Medicare, Medi-Cal and Managed Care billing requirements and regulations
- Experience with Commercial insurance plans
- Familiarity with Managed Care, HMO/PPO billing processes
- Understanding of Medicaid billing procedures
Technical Skills:
- Knowledge of DOFR (Division of Financial Responsibility) requirements
- Understanding of payer contracts and contract rates
- Experience navigating payer portals for eligibility, claim submission and follow-up
- Proficiency with fee schedules and reimbursement rates
- Strong analytical skills for reviewing and resolving billing discrepancies
Preferred Qualifications:
- Experience with pathology and/or professional billing processes and procedures
- Additional certifications in medical billing or coding (CPC, CCS, CBCS)
- Experience with electronic health records (EHR) systems and billing systems (Waystar)
- Knowledge of HIPAA compliance requirements
Key Responsibilities:
- Process and submit medical claims accurately and efficiently
- Review and resolve claim denials and rejections
- Monitor aging reports and follow up on outstanding claims
- Handle overpayment processing and refund requests
- Maintain current knowledge of payer requirements and contract terms
- Communicate with insurance companies to resolve billing issues
- Ensure compliance with all regulatory requirements
- Collaborate with clinical staff to obtain necessary documentation
Skills and Attributes:
- Strong attention to detail and accuracy
- Excellent communication and problem-solving skills
- Ability to work independently and manage multiple priorities
- Proficiency in medical billing software and Microsoft Office
- Understanding of medical terminology and procedures
- Commitment to maintaining patient confidentiality
What We Offer:
- Competitive salary commensurate with experience
- Comprehensive benefits package
- Professional development opportunities
- Collaborative work environment
Job Type: Full-time
Pay: $23.00 - $28.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Flexible spending account
- Health insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Work Location: In person
