The Medical Billing Specialist is responsible for reviewing, preparing, and submitting accurate medical claims to insurance carriers in a timely manner. This role ensures that all charges are supported by appropriate documentation, coding, and payer requirements prior to claim submission. The Medical Biller works closely with coding, prior authorization, and clinical teams to resolve claim discrepancies, correct errors, and ensure clean claims are submitted on the first pass whenever possible. The position plays a critical role in maintaining billing accuracy, minimizing denials, and supporting efficient revenue cycle operations.
Essential Duties and Responsibilities:
Review patient encounters and charges to ensure accuracy and completeness prior to claim submission.
Submit professional claims electronically and through payer portals in accordance with payer requirements and internal billing timelines.
Verify that CPT, HCPCS, modifiers, and ICD-10 codes are present and supported by provider documentation prior to billing.
Review and correct claim edits
Work closely with coding and clinical teams to clarify documentation discrepancies impacting claim submission.
Identify trends in documentation errors and claim edits and report findings to management.
Ensure claims are submitted within timely filing requirements for all insurance carriers.
Maintain patient confidentiality and comply with all HIPAA policies and organizational guidelines.
Assist with special projects and workflow improvements as assigned.
Required Skills and Abilities:
Ability to organize workload and manage time effectively
Ability to establish and maintain effective working relationships with providers, management, employees, and the public
Strong computer and data entry skills
Ability to review claims for accuracy prior to submission
Ability to interpret payer billing guidelines and requirements
Ability to handle a high volume of work with speed and accuracy
Ability to identify and resolve claim errors prior to submission
Able to multi-task and work quickly with constantly changing circumstances and priorities
Strong attention to detail
Problem solving and critical thinking skills