Position Summary

The Medical Billing Specialist is responsible for accurately posting charges, payments, and adjustments while ensuring compliance with coding and billing guidelines. This position serves as a key point of contact for patients with billing concerns and works collaboratively with the front office, clinical team, and Billing Office Supervisor to ensure timely and accurate claim submission, payment posting, and account resolution.

Duties and Responsibilities

Patient Interaction & Customer Service

• Greets all patients with billing concerns/questions in a professional and courteous manner, resolving issues in a timely fashion.
• Answers incoming Billing Office calls and retrieves voicemail messages promptly.
• Requests unique identifiers from all callers before providing confidential account information.
• Creates and manages patient payment plans within Billing system and provides patients with written schedules.
• Meets daily/weekly requirements for collection calls on past-due balances.

Charge Entry & Coding

• Reviews encounter forms for accuracy, including ICD-10 and CPT coding, prior to posting charges.
• Verifies all required fields are completed before posting to minimize claim denials.
• Codes surgical and consult encounters using reference materials and established protocols.
• Assists clinical staff and physicians with coding questions when needed.

Payment Posting & Reconciliation

• Posts patient payments received by mail and balances daily transaction reports.
• Retrieves and verifies front office payments and transaction summaries according to schedule.
• Posts insurance payments, adjustments, and sequestration amounts accurately and timely.
• Balances daily batches of charges and payments, ensuring accuracy before leaving each day.
• Prepares deposits, maintains accurate Excel logs, and delivers deposits to the bank as scheduled.
• Ensures all charges/payments are posted before month-end close.

Claims & Collections

• Reviews and corrects daily error claims for resubmission to the clearinghouse.
• Works aging reports daily to resolve denied claims, following cleanup protocol and appeal processes.
• Prepares past-due patient accounts for collections and ensures supporting documentation is complete.
• Runs statements and manual claims according to schedule (Benchmark).
• Reviews and approves patient statement batches before release.

Documentation & Reporting

• Maintains accurate logs/worksheets assigned by the Billing Supervisor.
• Documents all account activity, communications, and payer updates in the patient account system.
• Print transaction summary reports and reconciles billing postings with the EMR system.
• Completes end-of-month close tasks accurately and timely.

Teamwork & Compliance

• Collaborates with front office staff to verify insurance, guarantors, copays, and posting data.
• Demonstrates willingness to assist teammates with tasks during downtime.
• Appropriately uses internal paging system for communication.
• Comply with Billing Office policies, procedures, and confidentiality standards.
• Maintains a clean, organized, and secure work area at all times.

Qualifications

• High school diploma or equivalent required; associate degree preferred.
• Minimum of 2 years of medical billing experience in a physician practice or healthcare setting.
• Knowledge of ICD-10 and CPT coding standards.
• Proficiency with EMR systems and billing platforms.
• Strong attention to detail, accuracy, and organizational skills.
• Excellent communication and customer service skills.
• Ability to meet daily, weekly, and monthly deadlines.
• Medical billing certification required.