Billing Representative / Specialist

Job Summary

The Billing Specialist I is responsible for performing insurance claim processing, billing, and follow-up to ensure timely and accurate reimbursement. This position serves as the primary contact for insurance companies and other payers, researching and resolving claim issues while maintaining compliance with billing regulations and organizational policies. The Billing Specialist I works closely with internal teams, including clinic staff and coding professionals, to optimize billing operations and support revenue cycle efficiency.

Essential Functions

• Submits and processes claims accurately and efficiently, ensuring compliance with payer requirements and company policies.
• Communicates with insurance companies, patients, and other stakeholders to resolve billing inquiries and maintain account status.
• Reviews and reconciles credit balances, reclassifies revenue, and processes adjustments per transaction coding guidelines.
• Monitors and resolves claim denials and rejections, identifying trends and implementing corrective actions.
• Reviews and corrects claim filing edits based on payer requirements and electronic health record (EHR) system alerts.
• Maintains accurate documentation of all billing actions in the practice management system.
• Gathers, updates, and communicates billing policy changes, ensuring accessibility of up-to-date reference materials.
• Collaborates with management, clinic staff, and coding teams to ensure proper billing and collection procedures.
• Assists patients and insurance representatives with billing-related questions while maintaining professionalism.
• Ensures compliance with HIPAA regulations and maintains confidentiality of patient financial and medical information.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree in a healthcare related field preferred or
• Technical School for Medical Billing/Coding preferred
• 0-2 years of experience in medical billing, insurance claims processing, or revenue cycle management required

Knowledge, Skills and Abilities

• Knowledge of medical billing processes, insurance claim procedures, and payer policies.
• Strong understanding of healthcare revenue cycle operations and reimbursement methodologies.
• Proficiency in electronic health records (EHR) and practice management systems (e.g., Athena, Cerner, Ingenious Med).
• Ability to interpret explanation of benefits (EOBs), identify billing discrepancies, and take corrective action.
• Excellent communication and interpersonal skills to interact with patients, providers, and payers professionally.
• Strong analytical and problem-solving abilities to research and resolve billing issues.
• Attention to detail and ability to manage multiple tasks while meeting deadlines.
• Working knowledge of HIPAA regulations and the importance of maintaining patient confidentiality.

Licenses and Certifications

• CPB- Certified Medical Biller issued by AAPC preferred or
• Certified Medical Insurance Specialist (CMIS) issued by PMI preferred