Medical Billing A/R Specialist

Job Summary
We are seeking a detail-oriented and experienced Medical Billing and Coding Specialist to join our team. The ideal candidate will be responsible for accurate CPT/ICD coding, ensuring compliance with billing regulations, and managing insurance claims and payments. This role requires strong knowledge of insurance guidelines, excellent communication skills, and proficiency with electronic health records (EHR) and billing software. The specialist will play a vital role in maintaining the integrity of billing processes and supporting the financial health of the organization.

Key Responsibilities
Perform precise CPT and ICD coding to guarantee accurate and compliant billing for all patient services. Review patient bills thoroughly to ensure accuracy and completeness, proactively obtaining any missing information to avoid delays. Apply comprehensive knowledge of insurance guidelines, including Medicare and Medicaid, to ensure proper billing practices are followed.

Follow up on unpaid claims within established billing cycles to maximize timely reimbursements. Verify that insurance payments align with contract discounts and compliance standards. Actively contact insurance companies to resolve any payment discrepancies or issues. Identify and bill secondary or tertiary insurance providers as necessary to optimize revenue collection.

Review accounts regularly for insurance or patient follow-up to maintain up-to-date records and resolve outstanding balances. Handle telephone inquiries from patients or insurance representatives related to assigned accounts with professionalism and clarity. Communicate effectively with team members and clients to facilitate smooth billing operations.

Manage accounts receivable processes, including denial management and appeal submissions, to recover denied or underpaid claims. Maintain detailed documentation and adhere to established protocols for all tasks performed. Assist management with additional duties as assigned, demonstrating flexibility and a team-oriented approach. Maintain strong verbal communication skills in English to ensure clear and effective interactions.

Required Qualifications
Demonstrated expertise in electronic health records (EHR) and medical billing software such as CureMD, Kareo, ECW, Practice Fusion, MS Office, Web Fax, Encoder Pro, and Payer Portals. Strong foundational knowledge of medical billing and coding practices, including familiarity with CPT and ICD coding standards.

Experience in denial management and appeals processes is essential, along with proficiency in handling authorization requests (pre-authorization, post-authorization, and retroactive authorization). Ability to conduct research and generate comprehensive management reports to support billing operations.

A collaborative team player with excellent verbal and written communication skills in English, including a good typing speed for efficient documentation. Familiarity with insurance accounts receivable workflows and adherence to the infrastructure code of conduct. Strong problem-solving and troubleshooting skills to address billing and payment challenges effectively.

Proven experience in accounts receivable follow-up and handling insurance calls, including the retrieval and interpretation of Explanation of Benefits (EOBs). Efficient communication with external entities, such as insurance companies and patients, to resolve billing inquiries and discrepancies.

Preferred Qualifications and Benefits
While not explicitly stated, candidates with additional certifications in medical billing or coding, such as CPC or CCS, and prior experience in a healthcare billing environment will be highly valued. Opportunities for professional growth and development within the organization may be available.

---

This role offers the chance to contribute significantly to the financial accuracy and compliance of our healthcare services. If you possess the required skills and are committed to excellence in medical billing and coding, we encourage you to apply.