Claims and Billing Specialist

PURPOSE OF POSITION:

The Claims and Billing Specialist will manage the full revenue cycle by reviewing, coding, and submitting medical claims to insurance and third-party billing company. The individual will work closely with the Data and Finance teams and is responsible for preparation and submission of claims, either directly to insurance carriers or through a third-party billing company to ensure all third-party billing claims, invoices and payments are processed in a timely manner. This position will also be responsible for reviewing client contracts for processing of an invoice to direct clients.

PRIMARY DUTIES AND RESPONSIBILITIES:

• Prepare, review, and transmit clean claims to insurance providers or third-party billing company as required.
• Process direct client invoices and send them promptly to client.
• Reconcile and post direct and third-party payments to the appropriate accounts.
• Communicate with client or third-party billing company on any issues, denials, or follow-ups to facilitate the prompt payment of accounts receivable.
• Responsible for tracking and resolving denied claims, as well as analyzing reimbursements according to contractual agreements.
• Respond timely to any client inquiries or requests.
• Maintain the client master.
• Demonstrate general knowledge of accounting and understanding of the general ledger accounts.
• Perform other general accounting duties as deemed necessary.

PHYSICAL DEMANDS:

• Prolonged periods sitting at a desk and working on a computer.
• Involves speaking to customers on the phone.

QUALIFICATIONS:

• Associate or bachelor’s degree in accounting or equivalent job experience. Must have claims experience.
• Must have strong Microsoft skills, especially Excel. QuickBooks knowledge is a plus.
• Experience with Electronic Health Records and billing software
• Must have the ability to organize with excellent attention to detail.
• Excellent communication skills (oral and written) necessary.