Billing Specialist

Department: Finance

Position Type: Full-Time

FLSA: Non-Exempt

Job Summary

The Billing Specialist is responsible for third-party remittance posting, accounts receivable follow-up, denial management, claim resolution, and billing system maintenance. This position works closely with insurance carriers, patients, providers, and internal departments to ensure timely reimbursement, accurate account management, and compliance with organizational and regulatory requirements. The Billing Specialist supports the overall success of the revenue cycle through effective collection activities, reporting, and maintenance of billing system data.

Duties/Responsibilities

• Verify third-party insurance coverage and coordination of benefits (COB).
• Post third-party insurance remittances accurately and timely.
• Research, resolve, and resubmit denied claims as necessary.
• Perform follow-up activities on aged and outstanding accounts receivable.
• Update patient referral and insurance information within the billing system.
• Collaborate with Case Management staff to resolve insurance-related issues.
• Contact patients regarding billing inquiries and account resolution.
• Complete compliance-related activities as directed.
• Maintain provider information within the billing system.
• Maintain insurance carrier information and billing codes within the billing system.
• Resolve clearinghouse, gateway, and payer-related issues as they arise.
• Generate ad hoc reports within Medent and analyze billing and collection data.
• Research billing discrepancies and implement corrective actions.
• Assist the Director of Revenue Cycle in the development and monitoring of key performance indicators (KPIs).
• Process laboratory billing and invoices.
• Support initiatives related to automation of cash receipt applications.
• Post electronic cash receipts to the general ledger in a timely manner.
• Reconcile and balance Pharmacy and Clinic deposits to the general ledger.
• Maintain confidentiality of all patient, client, proprietary, protected health information (PHI), and HIV-related information.
• Participate in compliance audits, process improvement activities, and quality improvement initiatives.
• Perform other duties as assigned.

Required Skills/Abilities

• Knowledge of medical billing practices, insurance reimbursement, and accounts receivable processes.
• Knowledge of medical terminology.
• Strong analytical, organizational, and problem-solving skills.
• Excellent verbal, written, and interpersonal communication skills.
• Proficiency in Microsoft Office applications, including Word and Excel.
• Experience utilizing electronic billing and practice management systems; Medent experience preferred.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Ability to work effectively with individuals from diverse backgrounds, cultures, races, sexual orientations, and gender identities or expressions.
• Ability to maintain strict confidentiality and exercise sound judgment when handling sensitive information.

Education and Experience

• High School Diploma or equivalent required.
• Associate of Applied Science (AAS) Degree in Business or a related field preferred.
• Minimum of three (3) years of experience in medical billing, accounts receivable, revenue cycle, or a related position required.
• Experience working in a nonprofit healthcare environment preferred.
• Proficiency with word processing, spreadsheets, and database applications required.

Physical Requirements

While performing the duties of this job, the employee is regularly required to stand, sit, walk, use hands to finger, handle, or feel; reach with hands and arms; and talk and hear. The employee may occasionally need to stoop, bend, and lift or move up to 25 pounds. Specific vision requirements include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.