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Medical Billing and Claims Specialist
Benefits:
- Bonus based on performance
- Opportunity for advancement
- Paid time off
Location: Pediatric Cardiology Consultants of South Texas (PCCST)
Job Summary:
The Billing and claims Specialist will play a critical role in managing the administrative and financial aspects of patient visits. The ideal candidate will provide excellent customer service, manage patient check-in/check-out, prior authorizations and handle billing tasks. This role also requires a detail-oriented individual who can manage patient accounts, verify insurance, and ensure the timely processing of claims and payments.
The Billing and claims Specialist will play a critical role in managing the administrative and financial aspects of patient visits. The ideal candidate will provide excellent customer service, manage patient check-in/check-out, prior authorizations and handle billing tasks. This role also requires a detail-oriented individual who can manage patient accounts, verify insurance, and ensure the timely processing of claims and payments.
Key Responsibilities:
- Front Desk Duties:
- Greet patients warmly and ensure a positive and professional experience.
- Manage patient check-in and check-out processes efficiently.
- Schedule patient appointments and follow-ups based on physician availability and patient needs.
- Maintain the reception area, keeping it clean, organized, and welcoming.
- Patient Information & Account Management:
- Update and maintain patient demographics by collecting personal and financial information.
- Verify insurance coverage and confirm eligibility prior to patient appointments.
- Explain insurance coverage to patients, including out-of-pocket costs, co-pays, and deductibles.
- Collect outstanding balances, co-pays, deductibles, and previous balances as needed.
- Billing & Insurance Processing:
- Manage billing processes and send claims to insurance companies using EMR (Athena).
- Handle prior authorizations and ensure all required documentation is submitted accurately.
- Communicate with insurance payers to ensure timely processing of claims and resolution of issues.
- Post charges, collections, and payments into the computer system and close daily batches.
- Monitor and follow up on unpaid claims, denials, or payment discrepancies to ensure timely reimbursement.
- Provide patients with detailed explanations of their bills, including procedures not covered by insurance.
- General Administrative Duties:
- Answer incoming phone calls, manage emails, and respond to patient inquiries regarding appointments, billing, or general clinic information.
- Assist in coordinating care with physicians, MAs, nurses, and other clinic staff.
- Ensure all patient documentation is completed accurately and filed appropriately.
- Participate in daily, weekly, or monthly meetings to review clinic operations, billing, and patient satisfaction metrics.
Qualifications:
- High school diploma or equivalent; additional education in healthcare administration or billing is a plus.
- Experience in a medical front office role
- Experience with Athena EMR is a plus
- Proficiency with billing, and claims management.
- Strong understanding of insurance verification, prior authorizations, and claims processing.
- Excellent communication and interpersonal skills with a patient-centric approach.
- Strong organizational skills and attention to detail.
- Ability to handle confidential information with professionalism.
Job Type: Full-time
Schedule:
- 8 hour shifts
- Monday to Friday
Education:
- High school diploma or higher
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