Senior Clinical Billing Specialist

Team: Account Executive

Accountabilities:

• Investigate and resolve complex physician and hospital account balances, identifying causes of non-payment and initiating claim corrections or resubmissions.
• Analyze denied claims, determine root causes, and prepare appeals within required timelines to prevent write-offs.
• Develop and submit appeal letters, gather supporting documentation, and ensure proper follow-up with payers.
• Perform cash reconciliation and ensure accuracy of financial and billing records.
• Assist patients with billing inquiries, insurance questions, and account clarifications via phone and electronic communication.
• Update patient and insurance information, verify coverage details, and ensure accurate claim submission and resubmission.
• Post payments, manage payment plans, and complete end-of-day processing activities.
• Support collections processes and coordination with external agencies to ensure continuity of revenue recovery.
• Interpret contract documents and apply billing guidelines accurately in account resolution.
• Prepare reports, analyses, and documentation to support operational decision-making and process improvements.
• Ensure compliance with HIPAA regulations, confidentiality standards, and organizational billing policies.
• Collaborate with internal departments to improve billing workflows and resolve systemic issues.

Requirements:

• High school diploma or GED with 5+ years of healthcare revenue cycle or bookkeeping experience; OR
• Associate’s degree with 3+ years of relevant healthcare billing or revenue cycle experience; OR
• Bachelor’s degree with 1+ year of healthcare revenue cycle experience or equivalent combination of education and experience.
• Strong understanding of medical billing processes, insurance claims, and revenue cycle operations.
• Experience with healthcare billing systems (EPIC preferred) and claims management tools.
• Knowledge of insurance policies, denial management, and appeals processes.
• Strong analytical and problem-solving skills with attention to detail and accuracy.
• Excellent verbal and written communication skills with the ability to interact professionally with patients and stakeholders.
• Basic mathematical skills and ability to manage financial data accurately.
• Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment.
• Solid understanding of HIPAA compliance and patient confidentiality requirements.

Benefits:

• Hourly compensation of $18.99/hr.
• Comprehensive benefits eligibility including medical, dental, and vision coverage.
• Paid time off including vacation, holidays, and sick leave.
• Retirement benefits with employer contribution matching options.
• Employee training and career development opportunities in healthcare administration.
• Education discounts for employees and eligible dependents.
• Supportive work environment focused on patient care, accuracy, and professional growth.
• Remote work eligibility after completion of onsite training, with required secure home office setup.