Job Summary

The Billing Specialist is responsible for accurate and timely submission of medical claims, and follow-up with payers and patients. This role ensures compliance with HIPAA and payer regulations while supporting efficient revenue cycle operations.

Key Responsibilities

·         Prepare, review, and submit clean claims to insurance payers (CMS-1500 and/or UB-04)

·         Verify patient insurance eligibility and coverage

·         Ensure accuracy of patient demographics, charges, and modifiers

·         Submit claims electronically and track claim status

·         Research claim denials and rejections

·         Correct errors and resubmit claims in a timely manner

·         Prepare and submit appeals with supporting documentation

·         Generate and review patient statements

·         Respond to patient billing inquiries professionally and clearly

·         Maintain compliance with HIPAA Privacy and Security Rules

·         Protect the confidentiality of all patient information

·         Out of network billing preferred but not required

·         Knowledge of Federal and State guidelines regarding NSA and TDI claims