Medical Billing and AR Specialist

Medical Billing and AR Specialist

The Medical Billing and AR specialist is responsible for overseeing and managing the performance of a third-party medical billing company to ensure accuracy, efficiency, and compliance with billing processes. This role involves monitoring outsourced billing operations, ensuring adherence to contractual agreements, and optimizing revenue cycle performance. The ideal candidate will have a strong background in medical billing, payer regulations, and revenue cycle management, along with excellent analytical and communication skills.

Key Responsibilities:

Third-Party Billing Oversight & Revenue Cycle Management:

· Serve as the primary liaison between the organization and the third-party billing company.

· Monitor outsourced billing processes to ensure timely claim submissions, payment postings, and denial management.

· Review and validate claims to prevent errors, rejections, and compliance risks.

· Track key performance indicators (KPIs) related to billing efficiency, accounts receivable (AR), and reimbursement rates.

· Ensure the third-party billing company complies with payer guidelines, coding standards (CPT, ICD-10, HCPCS), and regulatory requirements.

· Address escalated billing issues, including denials, appeals, and patient billing concerns.

· This role involves consistent communication with insurance carriers, healthcare providers, and clients to ensure accurate payment and timely resolution of claims

· The position ensures adherence to insurance policies and regulatory guidelines, focusing on reducing delays or denials in payments

· Review unpaid, underpaid, or denied insurance claims to identify and resolve issues

· Contact insurance companies to follow up on the status of claims, disputes, and pending payments

· Monitor and ensure that claims are processed within appropriate timeframes

· Identify errors in claims submission, such as incorrect coding or missing information, and work to correct them

· Address and resolve payment discrepancies, adjustments, or rejections by working with the appropriate parties

· Documentation and Record-Keeping

· Maintain accurate and up-to-date records of claim statuses, follow-up actions, and communications

· Ensure compliance with insurance company policies, industry regulations, and billing procedures

· Stay informed about changes in insurance regulations and claims processing requirements

· Maintain confidentiality and follow all legal and regulatory guidelines regarding claims and patient information

Compliance & Contract Management:

• Ensure third-party billing operations comply with HIPAA, Medicare, Medicaid, and commercial insurance policies.

• Regularly audit the billing company’s performance to identify discrepancies and areas for improvement.

• Review and manage contracts, service level agreements (SLAs), and reporting requirements with the billing vendor.

• Work with legal and compliance teams to resolve any billing-related compliance issues.

Reporting & Process Improvement:

• Analyze financial reports, AR aging, and reimbursement trends to identify revenue cycle inefficiencies.

• Provide regular performance updates to senior management, including recommendations for improvements.

• Collaborate with internal teams (finance, coding, and clinical departments) to align billing processes with organizational goals.

• Implement process improvements to enhance revenue cycle performance and reduce billing errors.

Qualifications & Skills:

• Education: High school diploma or equivalent required; associate degree or certification in healthcare administration or insurance would be preferred.

• Experience: 2 years in medical billing or revenue cycle management, with experience overseeing third-party billing services (preferred).

• Certifications: Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or similar (preferred).

• Technical Skills: Proficiency in billing software, electronic health records (EHR) systems, and financial reporting tools. Proficiency in Microsoft Office Suite, especially Excel and Word.

• Knowledge: Strong understanding of insurance claims, CPT/ICD-10 coding, Medicare/Medicaid rules, and revenue cycle analytics.

• Soft Skills: Strong leadership, analytical thinking, problem-solving, contract management, and communication skills.

How to Apply:

Interested candidates can apply by submitting their resume to ADMIN@zenithfamilycare.com

Job Types: Full-time, Part-time

Expected hours: No less than 20 per week

Benefits:

• 401(k)
• Flexible schedule
• Health insurance
• Paid time off

Schedule:

• Choose your own hours
• No nights
• No weekends

Work Location: Hybrid remote in Marlborough, MA 01752