Billing Specialist

The Billing Specialist is responsible for timely, accurate, and comprehensive billing of all provider services utilizing appropriate CPT, HCPCS, and ICD-10 diagnosis codes. The individual prepares and submits clean claims to Medicare, Medicaid, Commercial insurance carriers, and Self-Pay patients, and works rejections.

• Submits claims to payers based on review of medical records and in accordance with Medicare, Medicaid, and Commercial insurance guidelines as well as FHCSWF policies and procedures.
• Reviews information necessary for insurance claims such as patient, insurance , diagnosis and treatment codes and modifiers, and provider information to ensure clean claim submission.
• Enters charges accurately and expeditiously to ensure proper records handling and fast payment.
• Timely filing of insurance claims to clearinghouse or individual insurance companies electronically or via paper.
• Review and correction of claim edits within 24 hours of being received from clearinghouse and internal claims scrubber.
• Initiates private pay collections after insurance cancellation, denial or other issue and answer patient questions on patient responsible portions, copays, deductibles, write-offs, etc.
• Performs self-pay patient billing.
• Prepares and sends patient statements for charges not covered by insurance.
• Other duties as assigned.

• Demonstrated knowledge of Medicaid, Medicare, and Commercial Insurance rules and procedures in a managed care plan environment
• Medical terminology, CPT, HCPCS and ICD-10 coding and modifier usage
• Understanding of FQHC billing procedures and Sliding Fee Schedules a plus
• EHR systems expertise, preferably with Intergy or other ambulatory care facility‑based system
• Understand and adhere to all HIPAA guidelines
• MS Office Suite (Excel proficiency)
• Alpha‑Numeric data entry

• High School or Equivalent (Associates Degree preferred)
• 2 Years Medical Billing experience
• CMRS, CPB, or CPC credentials a plus
• Attention to detail with strong documentation, analytic and problem‑solving skills
• Ability to multi‑task in a fast‑paced environment
• Strong interpersonal written & verbal communication skill