We Are Hiring!

Medical Billing Specialist – Full-Time Remote

Position Summary

The Medical Billing Specialist is responsible for ensuring accurate and timely reimbursement for services rendered by the clinic. This position performs a variety of revenue cycle functions, including accounts receivable follow-up, medical coding, payment posting, denial management, refund processing, and insurance verification. The ideal candidate demonstrates strong analytical/communication skills, attention to detail, and a thorough understanding of medical billing regulations, payer requirements, and coding guidelines. 

Essential Duties and Responsibilities

Accounts Receivable Management

• Monitor and manage accounts receivable aging reports, prioritizing high-dollar balances and timely filing deadlines.
• Research, investigate, and resolve unpaid, underpaid, and denied insurance claims.
• Prepare and submit appeals for denied claims with appropriate supporting documentation.
• Follow up with insurance carriers regarding outstanding claims and reimbursement issues.
• Monitor payer turnaround times and identify reimbursement trends.
• Maintain detailed documentation on aging accounts and provide monthly status reports to the Billing Team Lead and Administration.
• Perform skilled nursing facility (nursing home) billing based on accounts receivable reports.

Unapplied Payments

• Research and resolve unapplied or unidentified payments.
• Accurately post or reallocate payments to the appropriate patient accounts.
• Resolve credit balances related to unapplied payments.
• Collaborate with payment posting staff to identify and prevent recurring posting issues.
• Routinely monitor unapplied payment balances to ensure timely resolution.

Refund Management

• Review patient and insurance credit balances for refund eligibility.
• Process patient and insurance refunds accurately after obtaining required approvals.
• Maintain complete refund logs with supporting documentation.
• Ensure all refunds comply with payer contracts, clinic policies, and applicable federal and state regulations. Receivable reports.

Medical Coding

• Assign ICD-10-CM, CPT, and HCPCS codes to physician services, laboratory services, and nurse visits using current coding guidelines.
• Review provider documentation for completeness and accuracy prior to coding.
• Submit provider queries when documentation is incomplete or clarification is needed.
• Code encounters accurately and efficiently to support timely claim submission while maintaining compliance with payer and regulatory requirements.

Payment Posting

• Assist with posting electronic remittance advice (ERA) payments and paper check payments.
• Verify payment accuracy according to payer contracts.
• Investigate and resolve flagged or exception payments.
• Route denied claims to the appropriate work queues or provider folders for follow-up.

Insurance Verification and Claims Management

• Verify patient insurance eligibility and benefits.
• Monitor claim status and resolve claim rejections or edits.
• Assist with claim submission issues to promote timely reimbursement.

Additional Responsibilities

• Perform data entry and maintain accurate billing records.
• Maintain confidentiality of patient information in accordance with HIPAA regulations.
• Participate in departmental meetings, education, and quality improvement initiatives.
• Stay current on coding updates, payer policies, and billing regulations.
• Perform other duties as assigned by management.
• Assist with identifying missing charges.

Qualifications

• High school diploma or equivalent required; Associate's degree in Healthcare Administration, Medical Billing and Coding, or related field preferred.
• Medical billing experience required; medical coding experience preferred.
• RHIT, CCS-P, or CPC certification preferred.
• Knowledge of Medicare, Medicaid, commercial insurance, denial management, and revenue cycle processes preferred.
• Strong attention to detail and ability to work independently/efficiently in a remote environment.

Join our awesome team! Download the application form here and complete the form below for us to get to know you more. Medical office specialist and Referral Specialist. Please email application to Noemi Garcia ngarcia@colfamprac.com