Insurance Billing Specialist Ii, Revenue Cycle Medical Group

WHAT IT'S LIKE AT SGMC HEALTH Purpose

No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place.

We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service.

We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.

We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.

SGMC has great benefit options, depending on the role that you are going into – including healthcare, supplementary benefits, ways to save for the future, opportunities for career advancement, and opportunities to expand your skill set. Some of these great benefit options are listed below:

• Low Healthcare Insurance Premiums
• 401(k) with employer match
• Paid Time Off (PTO)
• Employee discounts
• Company paid life insurance
• Short-Term and Long-Term Disability
• Cancer Insurance
• Accident Insurance
• Pet Insurance
• Tuition Reimbursement
• On-the-job training and skills development
• Opportunities for growth and advancement
• Employee Assistance Program

SGMC Patient Financial Services

Revenue Cycle Medical Group

Full Time, 8 HR Day Shift, 8-5

The Insurance Billing Specialist II is an advanced individual contributor responsible for the accurate and timely billing, follow up, and resolution of professional claims for employed and contracted SGMC providers. This role serves as a senior billing resource, handling complex claims and simple denials, providing payer specific expertise, and supporting overall revenue cycle performance. In addition to performing all core functions of an Insurance Billing Specialist, the Insurance Billing Specialist II independently manages higher complexity accounts, serves as a subject matter expert for assigned payers or denial categories, and provides guidance and support to peers.

This position does not have formal supervisory responsibility, but is expected to demonstrate leadership through expertise, mentorship, and accountability for outcomes. Progression into this role is based on demonstrated competency, performance, and organizational need.

• High school graduate or equivalent required.
• Certified Patient Account Representative certification required.

• Two (2) or more years of professional billing experience with complex payer exposure.
• Experience supporting denial management, appeals, or payer projects.

• Advanced knowledge of professional billing and reimbursement processes.
• Extensive understanding of Medicare, Medicaid (Georgia and Florida), managed care, commercial payers, and government programs.
• Advanced ability to interpret and analyze EOBs and remittance advice.
• Strong working knowledge of CPT 4, HCPCS, ICD 10, and professional claim (CMS 1500) requirements.
• Thorough understanding of payer timely filing rules, coordination of benefits, and secondary payer guidelines.
• Ability to independently research payer policies and apply findings to claim resolution.
• Proficiency in Epic PB Resolute Billing and payer web portals.
• Strong analytical, organizational, and problem-solving skills.
• Ability to communicate effectively with patients, payers, providers, and internal departments.
• Demonstrated ability to work independently with minimal supervision.
• Ability to mentor peers and provide constructive guidance.
• Strong attention to detail with a high level of accuracy.
• Excellent customer service skills.
• Knowledge of HIPAA privacy and compliance requirements.

May spend long hours working at computer terminal. Must be able to see and read names, numbers, and colors. This position is subject to high stress levels. The role has the ability to function as a hybrid position, however the incumbent must have and maintain reliable high-speed internet and is able to agree to organizations IT Security policies for remote access work should leadership allow remote work.