The Medical Billing Specialist supports daily billing operations to ensure accurate and timely claim submission, payment posting, and resolution of rejections or denials.
This role focuses on managing claim volume in Athena and ensuring compliance with payer requirements and healthcare regulations.
This role also serves as a primary point of contact for patients and caregivers, handling billing-related inquiries via phone or email, providing clear and professional support.
Submit and manage claims in Athena, ensuring accuracy and completeness prior to submission.
Verify and enter charges accurately; review prior-day submissions to identify and correct any rejections promptly.
Apply CPT and ICD-10 coding standards when processing claims.
Serve as a first point of contact for patients or caregivers with billing questions via phone or email; resolve inquiries professionally and empathetically.
Communicate with clinical and administrative teams to gather any missing or corrected information needed for claims.
Post payments and reconcile accounts as assigned.
Monitor claim status and follow up with payers to ensure prompt payment.
Maintain compliance with HIPAA and healthcare billing regulations.
Requirements
2+ years of experience in medical billing or revenue cycle operations.
Familiarity with Athena billing and EHR platform is strongly preferred.
Strong understanding of billing practices, particularly for mental health or dementia care services.
Knowledge of Medicare, Medicaid, and commercial payer billing requirements.
Knowledge of CPT and ICD-10 coding standards.
Demonstrated ability to research and resolve claim denials.
Comfortable working in a high-volume, detail-driven environment.
Excellent communication and organizational skills.
Ability to handle sensitive patient information confidentially and in compliance with HIPAA.