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The Billing Specialist II is responsible for managing complex billing functions, ensuring timely and accurate claims processing, and resolving issues related to insurance payments and account balances. This position serves as the primary contact for insurance companies and other payers, performing in-depth research to facilitate claim resolution and maximize collections. The Billing Specialist II also supports team training, assists with audits, and ensures compliance with payer regulations and company policies.
Essential Functions
- Serves as the primary point of contact for insurance companies, payers, and patients regarding billing inquiries and claim resolution.
- Reviews and processes insurance claims, ensuring timely submission and compliance with payer guidelines.
- Identifies and resolves credit balances, reclassifies revenue, and processes adjustments according to transaction coding policies.
- Reviews and corrects claim filing edits in electronic health record (EHR) and practice management systems (e.g., Athena, Cerner, Ingenious Med).
- Researches and resolves claim denials and rejections, working proactively to identify trends and implement corrective actions.
- Monitors and works vendor/payer audit trails, submitting secondary claims and addressing discrepancies as needed.
- Maintains up-to-date knowledge of federal, state, and payer billing guidelines, utilizing payer websites for claims follow-up.
- Assists in training staff and providers on billing updates, maintaining a centralized electronic repository for reference materials.
- Ensures proper billing and collection procedures in collaboration with management, clinic staff, and coding teams.
- Maintains confidentiality and ensures compliance with HIPAA regulations and company policies.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
- 2-4 years of experience in medical billing, insurance claims processing, or revenue cycle management required
- 1-3 years in collections, knowledge of third party billing, and insurance reimbursement required
- 0-1 years of experience with Medicare preferred
- Advanced knowledge of medical billing processes, insurance claim procedures, and payer policies.
- Strong understanding of revenue cycle management, including insurance reimbursement and claim adjudication.
- Proficiency in electronic health records (EHR) and practice management systems.
- Ability to analyze and resolve complex billing issues, including denials and payment discrepancies.
- Strong communication and problem-solving skills to interact with patients, providers, and payers.
- Ability to train and mentor team members on billing best practices.
- Detail-oriented with the ability to meet deadlines and manage multiple priorities.
- Working knowledge of HIPAA regulations and data confidentiality requirements.
- CPB- Certified Medical Biller issued by AAPC preferred or
- Certified Medical Insurance Specialist (CMIS) issued by PMI preferred
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