Job Description

Job Summary

The Billing Specialist is responsible for accurate and timely submission of medical claims, and follow-up with payers and patients. This role ensures compliance with HIPAA and payer regulations while supporting efficient revenue cycle operations.

Key Responsibilities

· Prepare, review, and submit clean claims to insurance payers (CMS-1500 and/or UB-04)

· Verify patient insurance eligibility and coverage

· Ensure accuracy of patient demographics, charges, and modifiers

· Submit claims electronically and track claim status

· Research claim denials and rejections

· Correct errors and resubmit claims in a timely manner

· Prepare and submit appeals with supporting documentation

· Generate and review patient statements

· Respond to patient billing inquiries professionally and clearly

· Maintain compliance with HIPAA Privacy and Security Rules

· Protect the confidentiality of all patient information

· Out of network billing preferred but not required

· Knowledge of Federal and State guidelines regarding NSA and TDI claims

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