Clinic Billing Specialist

Overview

Under general supervision, the Clinic Billing and Follow‑up Specialist handles essential billing and insurance follow‑up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow‑up with insurers to ensure claims resolution. The position encompasses business office responsibilities related to patient accounts, including charge import, appeals, diagnostics and procedural coding, and claim follow‑up with third‑party payers to achieve a zero‑balance resolution.

Under general supervision, the Clinic Billing and Follow‑up Specialist handles essential billing and insurance follow‑up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow‑up with insurers to ensure claims resolution. The position encompasses business office responsibilities related to patient accounts, including charge import, appeals, diagnostics and procedural coding, and claim follow‑up with third‑party payers to achieve a zero‑balance resolution.

Position is On‑Site with Hybrid work option after at least six months

• Promote the mission, vision, and values of the organization
• Import charges from queues in a timely manner and append modifiers or any required information for claim transmission
• Review daily accounts that are ready to be billed in Waystar from Meditech
• Initiate correction on all claims with errors by the designated time
• Follow up on any correspondence that may have been received on that day or the previous day
• Cross train on billing all lines of business to the different payers
• Pull listing of all accounts assigned to be follow up by specific payer
• Diagnostic and procedural coding

• Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.
• Communicate with third‑party representatives as necessary to complete claims processing and /or resolve problem claims.
• Follow‑up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts.
• Maintain accounts receivable detail of their accounts through tasking.
• Maintains standards per payer for percentage accounts > 90 days .
• Works minimum standard number of accounts per payer per day.
• Meets or exceeds collection goals by payer each month.
• Works all assigned accounts as assigned, depending on balance.
• Complete appeals as required .
• Participates in educational activities and attends monthly department staff meetings.
• Maintains confidentiality: adheres to all HIPAA guidelines/regulations.
• Other duties as assigned from time to time.
• Attend educational activities and monthly department staff meetings
• Perform other duties as assigned

• High School Diploma or GED
• Six months previous experience in clinic registration, billing and collections, financial counseling, or customer service preferred
• Knowledge of medical terminology preferred
• Basic computer proficiency
• Typing speed: minimum 40 WPM
• Familiarity with CPT and ICD-9 coding is helpful
• Good written and verbal communication skills are essential for account follow‑up