Billing Specialist

The Billing Specialist is responsible for ensuring the timely and accurate processing of medical claims while supporting all aspects of the revenue cycle. This position works collaboratively with insurance companies, healthcare providers, patients, and internal departments to resolve billing issues, maximize reimbursement, and provide exceptional customer service. The Billing Specialist maintains patient account accuracy, investigates denied or unpaid claims, assists patients with billing questions, and supports the organization's financial performance through effective billing and collections processes.

RESPONSIBILITIES

• Claims Processing & Insurance Follow-Up
  • Submit, review, and monitor insurance claims for timely processing and reimbursement.
  • Investigate unpaid, denied, or underpaid claims and initiate appeals when appropriate.
  • Work directly with insurance carriers, providers, and patients to resolve claim issues.
  • Cross departmental support

• Billing Operations
  • Coordinate and validate electronic claims transmissions to ensure edit criteria are met.
  • Research and resolve claim edits, billing errors, and unbilled accounts.
  • Collaborate with clinical, registration, and revenue cycle staff to resolve billing discrepancies.
  • Review patient accounts to ensure accurate billing practices and appropriate reimbursement.
  • Quality assurance & process improvement

• Patient Account Management
  • Maintain accurate patient demographic, insurance, billing, and clinical information within the electronic health record and billing systems.
  • Respond to patient billing inquiries and resolve concerns professionally and promptly.
  • Collect and process patient payments, including co-pays, deductibles, and outstanding balances.
  • Maintain patient confidentiality in accordance with HIPAA and organizational policies

• Collections & Financial Counseling
  • Perform collection activities, including contacting patients regarding outstanding balances.
  • Correct and resubmit claims to third-party payers as needed.
  • Establish payment arrangements and educate patients when appropriate.

• Quality & Operational Support
  • Monitor billing work queues to ensure timely account follow-up.
  • Identify billing trends, reimbursement issues, and opportunities for process improvement.
  • Maintain current knowledge of insurance regulations, payer guidelines, and billing requirements.
  • Assist with Credentialing requirements pertaining to all MMA providers 

POSITION REQUIREMENTS

• High School diploma required, Bachelor’s degree preferred
• One year experience in billing, customer care, account management, or a similar role.
• Experience in a healthcare setting working with information systems including an understanding of medical billing terminology, insurance plans, and claims processing.
• High attention to detail and accuracy.
• Strong organizational and multitasking abilities.
• Ability to work both independently and collaboratively.
• Excellent communication and interpersonal skills.

WORK SETTING

• This position is eligible for a hybrid work arrangement following the successful completion of training and orientation.
• This position requires the ability to work both independently and collaboratively in a fast-paced, multi-departmental environment. Flexibility is key, as tasks may shift based on operational needs and special projects. 
• Occasional travel between MMA locations may be required to support special initiatives or provide on-site assistance as needed.

REPORTING RELATIONSHIP

This position reports to the Senior Manager of Revenue Cycle and the Revenue Cycle Team Lead.