JOB SUMMARY

We are seeking a detail-oriented and experienced Medical Billing Specialist (Claims + Payment Posting) to support our revenue cycle operations by ensuring accurate claims submission, timely follow-up, proper payment posting, and resolution of billing issues.

This role focuses primarily on processing claims, managing rejections/denials, posting payments (ERAs/EOBs), handling adjustments, and maintaining accurate patient and payer balances. The ideal candidate is highly organized, understands payer rules, and can manage multiple claims and payment workflows efficiently.

KEY RESPONSIBILITIES

Claims Submission & Follow-Up

- Prepare, review, and submit clean claims electronically and/or via paper when needed.

- Verify that charges, modifiers, diagnosis codes, and provider information are accurate prior to submission.

- Monitor claim status through clearinghouse and payer portals.

- Resolve rejected claims quickly by correcting errors and resubmitting.

- Work denials and underpayments by identifying root cause and initiating corrections or appeals.

- Follow up on unpaid claims and aging accounts to reduce A/R days.

- Coordinate with clinical/admin teams to obtain missing documentation needed for billing.

Payment Posting & Reconciliation

- Post insurance payments accurately using ERAs (electronic remittance advice) and manual EOBs.

- Post patient payments and properly apply to the correct claim/encounter.

- Review payment variances and ensure contractual adjustments and write-offs are applied correctly.

- Process refunds, recoupments, and payment reversals when necessary.

- Ensure accurate account balances and assist with reconciliation reports.

- Maintain proper documentation and notes for all payment actions.

Patient Billing Support (as needed)

- Assist with patient statements, patient balance inquiries, and payment plans (if applicable).

- Identify secondary coverage opportunities and coordinate COB (coordination of benefits).

Billing Compliance & Documentation

- Maintain compliance with payer billing requirements, HIPAA, and company policies.

- Ensure supporting documentation is correct and available for audits.

- Maintain accurate tracking logs and workflow documentation.

Collaboration & Process Improvement

- Work closely with credentialing, authorizations, scheduling, and clinical teams to prevent billing issues.

- Identify trends in denials and rejections and communicate recurring issues to management.

- Support implementation of billing workflow improvements to increase efficiency and accuracy.

REQUIRED QUALIFICATIONS

- 2+ years of medical billing experience (claims and payment posting required).

- Strong understanding of claims lifecycle, clearinghouse processes, and payer portals.

- Experience working with ERAs, EOBs, CPT/ICD-10/HCPCS coding concepts, modifiers, and adjustments.

- Familiarity with Medicare, Medicaid, and commercial insurance billing rules.

- Strong attention to detail and ability to manage high-volume tasks.

- Proficiency with EHR/PM systems and Microsoft Office (Excel preferred).

PREFERRED QUALIFICATIONS

- Experience in home health, home care, primary care, behavioral health, DME, or multi-specialty billing.

- Experience with authorizations, eligibility verification, and secondary billing.

- Billing certification preferred (CPB, CPC, CBCS, or equivalent).

- Bilingual (English/Spanish) is a plus.

SKILLS & COMPETENCIES

- Strong analytical skills and ability to resolve billing/payment discrepancies

- Excellent organization and time management

- Strong written and verbal communication

- Ability to work independently and meet deadlines

- Strong customer service skills when dealing with patients and payers

- Team-oriented and proactive problem-solving mindset

WHAT SUCCESS LOOKS LIKE IN THIS ROLE

- Accurate and timely claims submissions with low rejection rates

- Fast and accurate payment posting with minimal discrepancies

- Reduced aging A/R and improved collections performance

- Strong documentation and compliance with payer requirements

- Clear communication and teamwork to prevent recurring billing issues