Medical Billing and Accounts Receivable Specialist

Summary/Objective

Responsible for accurately processing patient billing, managing insurance claims, and ensuring timely reimbursement. Duties include reviewing medical records, coding procedures, and collaborating with healthcare providers and insurance companies to resolve discrepancies. Strong attention to detail, knowledge of medical terminology, and proficiency in billing software are essential for success in this role.

Essential Functions

- Verifies insurance benefits and confirm patient eligibility

- Obtains prior authorization for services as required

- Reviews clinician entered charges entered for accuracy before generating claims

- Prepares and submits claim files

- Posts insurance and clients payments accurately and in a timely manner

- Analyze and address ERA/EOB denials by taking appropriate corrective action

- Manage accounts receivable and actively pursue outstanding balances

- Oversee client collections to ensure timely payment

- Handle insurance appeals for denied or underpaid claims

- Stay informed and compliant with payor reimbursement policies, procedures, and guidelines

- Monitor and apply contracted fee schedules to ensure accurate expected payment

- Foster positive communication and relationships with patients, clinicians, physicians, third-party payors, and other Boundless staff)to ensure exceptional customer service

- Adheres to company policies and procedures in addition to regulations, laws and other requirements from applicable governing bodies, certification, licensure and/or accreditation entities, etc.

Other Responsibilities

- Other duties as assigned.

Supervisory Duties

This position has no supervisory responsibilities.

Education, Skills, Experience and Requirements

- High school diploma required; college coursework a plus.

- Preferred 1-3 years’ experience in medical billing and collections, as well as insurance verification.

- Proficient in Microsoft 365

- Medical Coding Certification (Preferred)

- Driver’s license and insurable driving record, if applicable.

Competencies and Attributes

Oral and written communication

Professionalism

Organizational skills

Ability to stay focused

Ability to prioritize multiple tasks

Computer skills

Professional phone etiquette

Physical Demands/% of time

Lifting and carrying up to 20lbs <25%

Standing and/or walking <25%

Near visual acuity >75%

Use of electronics (i.e. computer, tablet) >75%

Manual dexterity >75%

Use of office equipment (i.e. copier/scanner) >75%

Sitting >75%

Verbal communication >75%

Travel Requirements: Minimul travel is primarily local during the business day