Medical Billing Specialist

Established in 1984, Equitas Health is a regional not‑for‑profit community‑based healthcare system and federally qualified community health center look‑alike. Its expanded mission has made it one of the nation’s largest HIV/AIDS, lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) healthcare organizations. With 22 offices in 12 cities, it serves more than 67,000 individuals in Ohio, Kentucky, and West Virginia each year through its diverse healthcare and social service delivery system focused around: primary and specialized medical care, retail pharmacy, dental, behavioral health, HIV/STI prevention, advocacy, and community health initiatives.

$23.5577 to $32.9808 USD

The Medical Billing Specialist reports to the Revenue Cycle Manager and is responsible for various tasks to ensure efficient billing, follow‑up, payment processing, and patient communication activities to maximize revenue.

Essential functions of the job include, but are not limited to, medical and dental insurance understanding of coordination of benefits, claims processing, and follow‐up. Utilizing a computer for data entry, conducting research, electronic communications, attending meetings, drafting and distributing reports, interacting with others, reconciling data, and creating and updating spreadsheets.

• Working in EMR system work queues to process claims per coordination of benefits
• Review billing reports; ensure timeliness and accuracy of all claim submissions and billing procedures
• Prepare and submit clean claims to various insurance companies to include both paper and electronic
• Extensive insurance follow‑up and working knowledge of the appeals resolution process is required
• Responsible for contacting insurance companies and navigating insurance websites to secure and expedite payments
• Assisting in payment research in a timely and accurate manner
• Answer billing inquiries from patients, clerical staff and insurance companies
• Identify and resolve patient billing complaints
• Assist with patient inquiries for revenue department
• Review assigned work queues daily to ensure claims are timely
• Evaluate patient’s financial status and rebill claims in conjunction with team and third‑party billing company
• Follow and report status of delinquent accounts
• Perform various collection actions including contacting patients by phone
• Correcting and resubmitting claims to third‑party payers as appropriate in conjunction with Epic/Ochin
• Participate in educational activities and attends monthly staff meetings
• Maintain strict confidentiality; adhere to all HIPAA guidelines/regulations
• Perform other duties for Finance Department

• High school diploma and medical billing required
• Dental and/or Medical Coding Certification preferred but not required

• High school diploma required
• Three to five years of medical experience in a medical office setting and a combination of training and experience required
• One to three years of experience in insurance billing and/or equivalent training and experience preferred
• Medical Billing and Coding knowledge and/or education equivalent combination preferred
• Experience with Behavioral Health, Pharmacy, & Dental a plus
• Must have strong knowledge of CPT and ICD‑10 coding along with basic medical terminology skills required
• Experience with EMR (Electronic Medical Record) and medical billing software preferred (Epic or Epic/Ochin experience is preferred)
• Understanding of HIPAA compliance
• Knowledge of FQHC, Federal Qualified Health Care Centers Billing preferred
• Knowledge of third‑party operating procedures and practices
• Understanding of Commercial payer guidelines and denial management
• CMS/Medicaid/Medicare of OH claims and COB experience preferred
• Understanding of coordination of benefit requirements and credentialing with payers
• Proven record of exceeding goals; evidence of the ability to consistently make good decisions through a combination of analysis, experience and judgment; abilities in problem solving, project management and creative resourcefulness
• Must be proficient in use of Microsoft Office (Access, Excel, Word and…