Senior Billing Specialist (Primary Care/Medical)

The Senior Billing Specialist is responsible for reviewing and editing claims, submitting claims for payment, correcting errors, and resubmitting denied claims. This role also involves contacting insurance payers and patients when necessary and handling other Accounts Receivable duties as assigned. Experience working within primary care or comparable experience is strongly preferred, as the position will focus on billing and revenue cycle management for this area. The ideal candidate will have a deep understanding of healthcare billing processes and a proven track record in managing complex claims in these specialized settings.

Major Responsibilities:

• Monitor and post incoming remittances (bank transactions, 835 files, physical mail, and lock box scans)


• Reconcile the bank deposits with EHR payment posting daily. Coordinates efforts with the Finance Department


• Verify remittance against contractual rates


• Monitor denial trends properly by assigning unpaid claims to work queues


• Work and repossess unpaid claims to obtain payment


• Ensure that claims are submitted correctly, processed, and paid promptly.


• Analyses CHC’s Accounts Receivable to find root causes of billing issues and formulates corrections.


• Works Epic Work-Queues as assigned by the manager, investigating payment-related claims issues and preparing claims for submission to payors


• Performing collections activity with patients and insurance payors. Contacting them as necessary to perform duties, including phone calls and emails


• Maintain current working knowledge of all professional reimbursement issues. • Demonstrates understanding and commitment to the health center mission


• Demonstrates understanding and commitment to the established CHC Values and Standards • Perform all other job-related duties that may be assigned

Qualified candidates must possess the following combination of education and experience:

• Medical and/or specialty billing experience required


• Minimum of 1 year experience in:

• 
  
  
  
  • Monitoring and posting incoming remittances (bank transactions, 835 files, physical mail, and lock box scans)
  
  
  • Reconciling the bank deposits with EHR payment posting daily. Coordinating efforts with the Finance Department
  
  
  • Verifying remittance against contractual rates
  
  
  • Monitoring denial trends properly assigning unpaid claims to work queues
  
  
  • Working and repossessing unpaid claims to obtain payment
  
  


• Previous experience working with EPIC preferred


• High School diploma or GED required.


• Experience in third-party billing and collections preferred. ICD10 and CPT coding, contract compliance, and information reporting requirements.


• The ability to work independently and with teams to solve problems


• Strong Healthcare Revenue Cycle operational workflow knowledge