Job Description
Job Summary
The Billing Specialist is responsible for accurate and timely submission of medical claims, and follow-up with payers and patients. This role ensures compliance with HIPAA and payer regulations while supporting efficient revenue cycle operations.
Key Responsibilities
· Prepare, review, and submit clean claims to insurance payers (CMS-1500 and/or UB-04)
· Verify patient insurance eligibility and coverage
· Ensure accuracy of patient demographics, charges, and modifiers
· Submit claims electronically and track claim status
· Research claim denials and rejections
· Correct errors and resubmit claims in a timely manner
· Prepare and submit appeals with supporting documentation
· Generate and review patient statements
· Respond to patient billing inquiries professionally and clearly
· Maintain compliance with HIPAA Privacy and Security Rules
· Protect the confidentiality of all patient information
· Out of network billing preferred but not required
· Knowledge of Federal and State guidelines regarding NSA and TDI claims
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