Medical Billing Specialist

Department: Revenue Cycle Management (RCM)

Reports To: Billing Manager / RCM Supervisor

Position Overview

We are seeking a detail-oriented Medical Billing Specialist to support our Revenue Cycle Management operations. This role is responsible for ensuring healthcare services are accurately billed, processed, and reimbursed by insurance payers and patients.

The ideal candidate has a strong understanding of medical billing processes, coding standards, and payer requirements, and is committed to maintaining compliance and accuracy throughout the revenue cycle.

Key Responsibilities

• Insurance Verification: Verify insurance eligibility and patient coverage.

• Coding Review: Review clinical encounters and apply appropriate CPT, HCPCS, and ICD-10-CM codes.

• Claims Submission: Submit electronic claims through clearinghouse systems.

• Payment Posting: Post insurance payments and reconcile electronic remittance advice (ERA).

• Denial Management: Analyze and resolve claim denials and submit appeals when necessary.

• A/R Follow-up: Conduct follow-up on outstanding claims and accounts receivable.

Work Structure

Team members may be assigned to a primary area (claims processing, payment posting, or A/R follow-up). However, the role requires flexibility to assist across multiple RCM functions as operational needs evolve.

Qualifications

• Proficiency in medical terminology and coding guidelines.

• Familiarity with Electronic Health Record (EHR) and billing systems.

• Strong attention to detail and analytical skills.

• Deep understanding of HIPAA privacy and compliance requirements.

• Previous experience in medical billing or revenue cycle operations preferred.

Performance Metrics

Success in this role is measured by industry-standard KPIs:

• Clean Claim Rate

• Days in Accounts Receivable (A/R)

• Denial Rate

Join Our Team

If you are passionate about healthcare administration and revenue cycle excellence, we invite you to apply and become part of our growing team.