Job Summary
The Billing Specialist I is responsible for processing, auditing, and submitting primary and secondary insurance claims, ensuring accuracy, compliance, and timely reimbursement. This role utilizes electronic claims management systems to review, correct, and resolve billing errors, denials, and rejections. The Billing Specialist I collaborates with internal teams, facility liaisons, and payers to ensure clean claim submission and adherence to federal, state, and payer-specific regulations.
Essential Functions
- Processes and submits primary and secondary insurance claims accurately and in a timely manner, ensuring compliance with payer guidelines and regulatory requirements.
- Reviews and resolves claim errors, rejections, and denials, making necessary corrections and resubmitting claims as needed.
- Demonstrates working knowledge of billing forms, including UB-04, CMS-1500, or state-specific billing forms, ensuring claims are submitted with the appropriate documentation.
- Audits claims for accuracy, checking for duplicate charges, overlapped accounts, and missing information before submission.
- Investigates and processes rebill requests, verifying claim accuracy and making necessary updates per facility or coding liaison direction.
- Maintains knowledge of billing regulations, payer policies, and electronic submission guidelines, staying up to date with federal, state, and local billing requirements.
- Utilizes electronic billing systems to analyze, research, and transmit claims, ensuring proper documentation of actions taken in the collection system.
- Monitors and reports charging or edit trends, collaborating with internal teams (such as coding, patient access, and ancillary departments) to improve billing accuracy.
- Performs daily balancing tasks using SSI and other billing systems, escalating unresolved issues or billing delays to the Billing Services Manager.
- Communicates professionally with payers, facility representatives, and internal teams, ensuring efficient issue resolution and proper follow-up on outstanding claims.
- Performs other duties as assigned.
- Complies with all policies and standards.
- This is a fully remote position.
Qualifications
- H.S. Diploma or GED required
- Associate Degree in Business, Healthcare Administration, Medical Billing, or a related field preferred
- 2+ years of experience and knowledge of ICD10 and CPT coding required
- 0-1 years of experience in medical billing, insurance claims processing, or revenue cycle operations required
- 1-3 years of billing experience in a medical facility, ambulatory surgery facility, or acute-care preferred
- Experience with hospital or physician billing, including knowledge of payer policies and electronic claims systems preferred
Knowledge, Skills and Abilities
- Basic understanding of insurance claim processing, medical billing, and reimbursement guidelines.
- Familiarity with billing software, electronic claims management systems (e.g., SSI, Pulse/DAR), and eligibility tools.
- Knowledge of CMS, Medicaid, Medicare, and commercial insurance billing regulations.
- Ability to analyze and resolve claim errors, denials, and rejections efficiently.
- Strong attention to detail, organizational skills, and ability to meet deadlines.
- Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic health record (EHR) systems.
- Excellent communication and problem-solving skills, with the ability to interact professionally with internal teams and external payers.
Licenses and Certifications
- CPB- Certified Medical Biller preferred
Originally posted on Himalayas
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