Clinic Billing Specialist

Under general supervision, the Clinic Billing and Follow-Up Specialist handles essential billing and insurance follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business office responsibilities related to patient accounts, including charge import, appeals, diagnostics and procedural coding, and claim follow-up with third-party payers to achieve a zero-balance resolution.FunctionsPromote the mission, vision, and values of the organizationImport charges from queues in a timely manner and append modifiers or any required information for claim transmissionReview daily accounts that are ready to be billed in Waystar from MeditechInitiate correction on all claims with errors by the designated timeFollow up on any correspondence that may have been received on that day or the previous dayCross train on billing all lines of business to the different payersPull listing of all accounts assigned to be follow up by specific payerDiagnostic and procedural codingFollow-Up ResponsibilitiesResponsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.Communicate with third-party representatives as necessary to complete claims processing and /or resolve problem claims.Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts.Maintain accounts receivable detail of their accounts through tasking.Maintains standards per payer for percentage accounts >90 days.Works minimum standard number of accounts per payer per day.Meets or exceeds collection goals by payer each month.Works all assigned accounts as assigned, depending on balance.Complete appeals as required.Participates in educational activities and attends monthly department staff meetings.Maintains confidentiality: adheres to all HIPAA guidelines/regulations.Other duties as assigned from time to time.Attend educational activities and monthly department staff meetingsPerform other duties as assignedHigh School Diploma or GEDSix months previous experience in clinic registration, billing and collections, financial counseling, or customer service preferredKnowledge of medical terminology preferredBasic computer proficiencyTyping speed: minimum 40 WPMFamiliarity with CPT and ICD-9 coding is helpfulGood written and verbal communication skills are essential for account follow-up

Created: 2025-10-04