Medical Billing Specialist

Position Summary

The Medical Billing Specialist is responsible for accurate medical claims processing, payment follow-up, prior authorization coordination, and billing compliance. This role supports timely reimbursement, resolution of billing discrepancies, and continuity of services through effective revenue cycle management and communication with payers and internal teams.

Essential Duties and Responsibilities

Medical Billing & Claims Processing

• Review and submit accurate medical claims within required timelines.
• Verify client information, insurance coverage, and billing details.
• Monitor claim status and follow up on unpaid, denied, or rejected claims.
• Investigate billing discrepancies and resolve issues with payers and internal teams.
• Post payments, adjustments, and denials in the billing system.

Authorizations & Insurance Coordination

• Obtain and track required prior authorizations for services, treatments, or procedures.
• Verify authorization requirements, submit supporting documentation, and follow up with payers on pending requests.
• Communicate authorization approvals, denials, and expiration dates to relevant staff and clients, as appropriate.

Payment Reconciliation & Reporting

• Support account reconciliation and maintain accurate billing and payment records.
• Assist with billing reports and identify opportunities to improve billing processes and revenue cycle operations.

Client Communication & Confidentiality

• Respond to client billing questions professionally and promptly.
• Maintain accurate records and protect confidential client information in accordance with applicable privacy requirements.

Compliance & Process Improvement

• Stay current with payer requirements, medical billing guidelines, and applicable regulations.
• Follow established billing procedures and support continuous improvement in billing accuracy and efficiency.

Qualifications

• At least five years of experience in medical billing, claims processing, prior authorizations, or revenue cycle operations.

• Familiarity with payer authorization requirements and medical billing practices.

• Experience with electronic health records and billing software.

• Strong attention to detail and ability to manage multiple claims and authorization deadlines.