The Medical Claims Billing Specialist is responsible for reviewing, researching, and resolving healthcare insurance claims to ensure accurate and timely reimbursement. This role focuses on correcting claim issues, submitting claims to insurance carriers, and performing timely collections on outstanding accounts.

Essential Duties & Responsibilities

• Review collection queues, Explanation of Benefits (EOBs), and correspondence for unpaid or underpaid claims.
• Research claim issues and resolve discrepancies appropriately.
• Interpret EOBs and insurance correspondence to determine required corrections or adjustments.
• Research exception reports and report findings to the Revenue Cycle Manager.
• Update patient and claim information by accessing internal and external systems.
• Resubmit corrected claims through billing systems as needed.
• Maintain accurate documentation, including MR notes, account status codes, and collection activity.
• Provide account updates and collection progress reports as requested.
• Assist patients with billing questions and payment processing.
• Process payments accurately using Z-Pay application.
• Assist in training staff on insurance processes and billing workflows when needed

Minimum Qualifications

• High School Diploma or equivalent required.
• Minimum of two (2) years of experience in medical accounts receivable or medical insurance claims processing.

Knowledge, Skills & Abilities

• Strong knowledge of medical insurance billing and claims processing.
• Proficiency with MS Windows, RIS systems, and internal billing platforms (MI system).
• Ability to operate standard office equipment (computer, copier, fax, calculator, shredder).
• Strong attention to detail and accuracy in data entry and claims review.
• Ability to manage multiple tasks simultaneously and meet deadlines.
• Professional communication skills with patients, insurance companies, and coworkers.
• Ability to learn and adapt to multiple software systems.
• Strong written and verbal communication skills.
• Commitment to maintaining HIPAA compliance and protecting PHI.

Working Conditions

• Standard office environment.
• Frequent computer and phone use.
• Interaction with insurance companies, patients, and internal staff throughout the day.

Physical Requirements

• Ability to sit and work at a computer for extended periods.
• Ability to lift up to 20 lbs (files and paper boxes).
• Frequent use of hands for typing and data entry.