Medical Billing Specialist

POSTION TYPE: Hybrid

PAY RANGE: $53,600 - $67,000 depending on years of experience

POSITION SUMMARY

The Medical Billing Specialist is responsible for managing insurance claims processing, accounts receivable, and insurance verification to ensure accurate and timely reimbursement for services. This position is responsible for key revenue cycle processes that have an impact on the company’s cash flow including but not limited to entering third party billing information and subsequent medical billings and ensuring all documentation is present and claims are billed in a timely manner and without error. This position will handle questions, complaints, or problems from insurance companies, Medicaid offices and their associated Managed Care Plans, Medicare regions and their associated Health Maintenance Organizations, and consumers regarding insurance payments.

Key Responsibilities

Claims Processing

• Prepare, submit, and track insurance claims (electronic and paper) to ensure timely reimbursement.
• Review claims for accuracy, ensuring proper coding and compliance with payer guidelines.
• Investigate, correct, and resubmit denied or rejected claims.
• Follow up with insurance companies on unpaid or delayed claims.

Accounts Receivable (AR) Management

• Monitor and manage outstanding balances from Medicaid, Medicare, and commercial insurance payers.
• Post payments, adjustments, and denials from insurance payers using electronic or paper EOB.
• Reconcile accounts and work with patients or payers to resolve outstanding balances.
• Generate AR reports and escalate overdue accounts as needed.

Insurance Verification & Authorization

• Verify patient insurance eligibility, coverage, and benefits using electronic 270/271 eligibility request and response files monthly at minimum. Updates system records accordingly.
• Obtain or verify pre-authorizations and referrals as required by insurance carriers.
• Communicate with patients regarding their coverage, co-pays, and out-of-pocket responsibilities.

Patient Billing & Support

• Generate and send patient statements for outstanding balances.
• Respond to patient billing inquiries and provide support in resolving billing issues.
• Assist in setting up payment plans when necessary.

 Compliance & Documentation

• Maintain accurate and up-to-date patient billing records.
• Ensure compliance with HIPAA, Medicare, Medicaid, and other regulatory billing requirements.
• Stay informed on changes in Medicaid, Medicare, and commercial insurance policies and billing regulations.

In addition to role responsibilities, each staff member of Community Connections has the following responsibilities as a part of their employment:

• Models and reinforces Community Connections mission to provide behavioral health, residential services, and primary health care coordination for marginalized and disenfranchised women, men, youth, and children living in the District of Columbia, many of whom are coping with challenges including mental illness, addiction, and the aftermath of trauma and abuse.
• Models and reinforces Community Connections values of quality, innovation, respect, equity, and integrity daily.
• Reinforces Community Connection’s commitment to diversity, equity, and inclusion.
• Protects the privacy of our consumer’s protected health information by maintaining compliance with HIPAA and other relevant CC related IT security regulations.
• Completes and stays current on role specific and organizational wide training.
• Performs other duties as assigned on an as-needed basis.

DESIRED KNOWLEDGE/SKILLS/ABILITIES:

• High School Diploma or equivalent required. Associate’s degree or certification in medical billing/coding preferred.
• At least 2 years of experience in medical billing, claims processing, and accounts receivable, preferably in a behavioral healthcare setting.
• Must have excellent computer knowledge and accurate keyboard skills
• Proficiency with Microsoft Office products
• Strong communication and customer service skills.
• Works with a high level of professionalism, integrity, and confidentiality
• Strong customer service orientation

POSITION TYPE/EXPECTED HOURS OF WORK

☐May need to work untraditional work hours such as weekends, evenings, observed holidays, and nights.

☐This is an essential or critical position which will require reporting to a physical work location or making visits to consumers in the community as defined by the business needs of Community Connections, Inc

☒This is a position which may report to work under an office occasional model as defined by the business needs of Community Connections, Inc

Salary : $53,600 - $67,000