Physician Practice Billing Specialist

JOB SUMMARY

Under the direction of the Director of Business Services and the Business Services Manager, the Physician Practice Billing Specialist performs physician practice billing functions to support timely and accurate reimbursement for services rendered. This position processes claims, resolves billing edits and denials, posts payments, reviews explanations of benefits (EOBs), and follows up on outstanding accounts. Follow-up activities may include appeals, patient responsibility statements, collection efforts, and communication with providers regarding missing information or coding-related concerns.

The Physician Practice Billing Specialist provides professional and responsive customer service to patients, providers, insurance carriers, and internal departments while supporting effective communication throughout the billing process. This role ensures compliance with federal and state regulations, payer requirements, medical coding standards, HIPAA guidelines, and organizational policies and procedures. The incumbent must demonstrate strong attention to detail, sound problem-solving skills, and the ability to work independently in a fast-paced healthcare environment.

Under the direction of the Director of Business Services and the Business Services Manager, the Physician Practice Billing Specialist performs physician practice billing functions to support timely and accurate reimbursement for services rendered. This position processes claims, resolves billing edits and denials, posts payments, reviews explanations of benefits (EOBs), and follows up on outstanding accounts. Follow-up activities may include appeals, patient responsibility statements, collection efforts, and communication with providers regarding missing information or coding-related concerns.

The Physician Practice Billing Specialist provides professional and responsive customer service to patients, providers, insurance carriers, and internal departments while supporting effective communication throughout the billing process. This role ensures compliance with federal and state regulations, payer requirements, medical coding standards, HIPAA guidelines, and organizational policies and procedures. The incumbent must demonstrate strong attention to detail, sound problem-solving skills, and the ability to work independently in a fast-paced healthcare environment.

• Review patient accounts for completeness and accuracy before claim submission, including demographic, insurance, coding, and billing information.
• Prepare, review, and submit clean electronic and paper claims to commercial insurers, government payers, and other third-party payers.
• Monitor claim submissions, payer edits, rejections, denials, delayed payments, and underpayments to support timely reimbursement.
• Investigate, correct, appeal, and resubmit rejected or denied claims with appropriate supporting documentation.
• Review explanations of benefits and remittance advice to verify reimbursement accuracy and identify payment discrepancies.

• Monitor accounts receivable aging reports and work assigned unpaid, denied, underpaid, delayed, and delinquent accounts to reduce outstanding balances and accounts receivable days.
• Research and resolve billing discrepancies, payer disputes, patient billing concerns, claim denials, and account variances in a timely manner.
• Complete appropriate collection activities, including patient follow-up, account documentation, and referral recommendations for delinquent accounts based on established criteria.
• Coordinate with physician offices, insurance companies, internal departments, and external agencies to resolve…