We are seeking a detail-oriented and experienced Medical Billing Specialist with a strong background in medical billing, coding, and insurance processes. The ideal candidate will be skilled in medical terminology, procedure coding, cost estimation, insurance appeals, and working within electronic health record systems. This role requires accuracy, excellent communication skills, and the ability to work with both patients and payers to ensure timely and correct reimbursement.

This position may offer the opportunity to work from home, depending on experience and performance.

Key Responsibilities:

Accurately process and submit medical claims to insurance companies, government payers, and other third-party organizations.

• Perform medical coding using ICD-10, CPT, and HCPCS standards for a variety of procedures and diagnoses.
• Generate and communicate cost estimates for procedures based on insurance coverage and contract agreements.
• Review and verify accuracy of billing data within EHR/EMR systems prior to claim submission.
• Utilize EHR/EMR platforms (such as Epic, Meditech, PrognoCis) for documentation, coding, and billing workflows.
• Research and resolve billing discrepancies or claim denials.
• Prepare and submit insurance appeals, ensuring compliance with payer guidelines.
• Communicate with patients regarding billing questions, payment responsibilities, and insurance coverage.
• Maintain up-to-date knowledge of medical terminology, payer requirements, and compliance regulations (HIPAA, CMS, etc.).
• Collaborate with clinical staff and providers to ensure accurate coding and documentation within electronic systems.
• Track accounts receivable and follow up on outstanding claims to maximize revenue.

Qualifications:

• High school diploma or equivalent required; Associate’s degree in Healthcare Administration, Billing & Coding, or related field preferred.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification strongly preferred.
• Minimum of 2 years of experience in medical billing, coding, insurance follow-up, and working within EHR/EMR systems.
• Strong knowledge of ICD-10, CPT, and HCPCS coding systems.
• Hands-on experience with electronic health record (EHR) and electronic medical record (EMR) systems, including Epic, Meditech, and/or PrognoCis.
• Familiarity with medical terminology, payer reimbursement guidelines, and healthcare regulations.
• Experience creating cost estimates for medical procedures.
• Skilled in preparing and submitting appeals for denied claims.
• Proficiency with medical billing software and electronic health record (EHR) systems.
• Strong attention to detail, problem-solving, and organizational skills.
• Excellent written and verbal communication skills.

Preferred Skills:

• Experience with Medicare/Medicaid billing and commercial insurance.
• Advanced knowledge of EHR/EMR workflows and system navigation.
• Ability to work independently and manage multiple tasks in a fast-paced environment.
• Customer service experience in a healthcare setting.