Medical Billing Specialist – Women's Health

This is a fully remote position, open to applicants in Texas.

📋 Description

• The Medical Billing Specialist is tasked with the prompt and precise submission of insurance claims, reviewing and amending denied claims for resubmission, and conducting reconciliations to ensure timely billing for services rendered.

• This role involves collaborating with patients, revenue cycle teams, work units, clinical personnel, and insurance providers to enhance the efficiency of the billing process and minimize the number of denied claims.

• The specialist reviews patient demographic and insurance details, confirming patient benefit information related to services provided by the clinic from various insurance providers.

• They gather essential medical documentation from clinicians to submit to insurance companies as needed for review and prior authorization of treatments.

• Authorization reference numbers are documented in EMR and/or other systems.

• The specialist updates and maintains EMR and/or other systems based on documentation provided by physicians or clinics for the creation of medical claims and/or posting self-pay charges to patient accounts.

• Preparing electronic claim files for submission is also part of the responsibilities.

• Monitoring accepted and denied claims, the specialist updates claims as necessary for resubmission.

• They compare transaction reports with daily schedules to ensure timely billing of all services rendered each month.

• Resolving and preparing paperwork for any credit balances, they also create statements for the collection of outstanding patient balances.

• Daily charge capture functions are performed in accordance with the guidelines set by each clinic in a timely and appropriate manner, including data entry of charges per patient into the EMR platform, eIVF.

• Charge reconciliation to the schedule for all patients seen daily is ensured.

• The specialist verifies the appropriateness of charges based on services provided and collaborates with Clinic leadership, RCM Leadership, and the Coding Team to maintain accuracy.

⛳️ Requirements

• A High School Diploma or equivalent is required, with an Associate’s degree preferred.

• A minimum of 1 - 2 years of medical billing experience is required in a women's clinic or physician practice environment.

• Experience in medical billing related to a lab and ASC setting is also preferred, with 1-2 years of relevant experience.

• Proficiency in CPT code sets and requirements, including but not limited to modifiers, CPT bundling/unbundling, proper diagnosis assignment, Evaluation and Management Codes, Lab Codes, and ASC HCPC code sets.

• Familiarity with claim edits and clearinghouse functionality is necessary.

• Knowledge of medical billing platforms used in clinic and physician practice settings is also required.

🏝️ Benefits

• Comprehensive Health Coverage: Medical, dental, and vision plans for our full-time employees, along with complimentary basic life insurance, Employee Assistance Program, and long-term disability insurance.

• FREE or low-cost employee-only healthcare coverage option is also available.

• Family Building Support: Take advantage of our comprehensive fertility benefits, adoption assistance, and surrogacy support to help grow your family.

• Paid Parental Leave: Generous maternity, paternity, and partner leave so you can focus on what matters most.

• Plenty of Paid Time Off: Start with 18 days of PTO annually and enjoy 11 paid holidays, including one floating holiday to use as you choose!

• Retirement Ready: Invest in your future with our 401(k) plan, featuring a competitive company match and full vesting after just 2 years.

• Lifestyle Spending Account: Access a company-funded account to reimburse expenses that boost your physical, financial, and emotional well-being.

• Health Savings Account (HSA): If eligible, enjoy regular employer contributions to your HSA with every paycheck.

• Rewards for Connections: Earn extra money with our Employee Referral Program —your network is invaluable!

• Growth Opportunities: We support your career with continuing education reimbursement and dedicated time off for professional development.

• Premium Calm Health Subscription: Enjoy a free premium Calm Health app subscription to support your mental wellness.

• Emotional & Work-Life Support: Through our Employee Assistance Program (EAP) with SupportLinc, you'll have access to emotional well-being and work-life resources whenever you need them.

• Extra Peace of Mind: Explore additional coverage options including Accident, Critical Illness, Hospital Indemnity, and Pet Insurance, to suit your needs.