Billing and Benefits Specialist

Consultants In Gastroenterology; West Columbia (SC); Hybride; USD 42 000 - 64 000; Plein temps

Avantages offerts par ce poste

Hybrid work options

On-site training

Résumé du poste

Consultants in Gastroenterology is seeking a Billing & Benefits Specialist to manage patient insurance verification, prior authorizations, claim submissions, and payment posting. This role bridges clinical services and payers to maximize clean-claim reimbursement and clear financial communication.

The position offers 40 hours/week, Monday–Friday, with hybrid or fully remote options. Initial on-site 1–2 week training will be conducted at West Columbia, SC.

Qualifications

• High school diploma or GED required.
• 2+ years medical billing and/or revenue cycle experience.
• Gastroenterology or surgical center background is a strong plus.
• Familiarity with CPT, ICD-10, HCPCS coding for GI.
• Experience with EHR and PM software.
• HIPAA compliance and PHI handling.

Responsabilités

• Verify patient insurance coverage and benefits prior to visits and GI procedures.
• Submit clean claims to insurers and manage denials/appeals.
• Post payments and reconcile accounts receivable.
• Handle patient billing inquiries and set up payment plans.

Connaissances

Communication

Attention to detail

Analytical problem solving

HIPAA compliance

Formation

High school diploma or GED

Associate degree or medical billing/coding certificate preferred

Outils

EHR software

Practice Management software

Description du poste

Job Details

Job Location: CIG WEST COLUMBIA - WEST COLUMBIA, SC 29169, Position Type: Full Time, Education Level: High School, Job Category: Admin - Clerical, Title: Billing & Benefits Specialist. Department: Billing. Reports to: Director of Operations. Position: Full-Time, Mon-Fri (40 hours per week) – Hybrid / Fully Remote Options (Initial On-site 1-2 Week Training @ West Columbia).

Company Description

Consultants in Gastroenterology is a specialized medical practice focused on providing high-quality digestive health care. Our skilled and experienced gastroenterology professionals perform cancer screenings, colonoscopies, upper endoscopies (including EGD and ERCPs), and endoscopic ultrasounds (EUS). The team is dedicated to delivering accurate diagnostics and effective treatments in a supportive environment. Applicants will join a clinical setting committed to patient-centered care and excellence in gastrointestinal medicine.

Role Summary

The Billing & Benefits Specialist manages patient insurance verification, prior authorizations, medical claim submissions, payment posting, and insurance/patient benefit inquiries. This role acts as a primary bridge between clinical services (such as office visits, colonoscopies, and endoscopies), insurance payers, and patients to maximize clean-claim reimbursement and ensure clear financial communication.

Key Responsibilities

Insurance Verification & Benefits

• Verify Coverage: Confirm active patient coverage, deductible status, and out-of-pocket maximums prior to scheduled office visits and specialized GI procedures (e.g., screening/diagnostic colonoscopies, EGDs).
• Prior Authorizations: Secure timely pre-authorizations and precertifications from commercial payers, Medicare Advantage, and Medicaid for office-based or ambulatory surgery center procedures.
• Benefit Explanations: Educate patients on their financial responsibility, co-pays, coinsurance, and deductibles in a transparent, compassionate manner.

Medical Billing & Revenue Cycle

• Charge Capture: Accurately enter and review charges using clinical documentation, ensuring proper linkage of CPT, ICD-10 (gastrointestinal diagnoses), and HCPCS codes.
• Claim Submission: Assemble and electronically submit clean claims to commercial insurers, Medicare, and Medicaid.
• Denials & Appeals: Investigate denied or rejected claims, compile necessary clinical notes/records, and submit formal peer‑to‑peer or written appeals.
• Payment Posting & Reconciliation: Post insurance and patient payments, reconcile ledgers against Explanations of Benefits (EOBs), and track accounts receivable (A/R).
• Patient Collections: Handle billing inquiries, resolve statement disputes, and set up reasonable payment plans.

Required Qualifications & Skills

• Education: High school diploma or GED required; associate degree, business/accounting coursework, or medical billing/coding certificate preferred.
• Experience: 2+ years of medical billing, insurance verification, or revenue cycle experience, ideally within a private physician practice or specialty clinic. (Gastroenterology or surgical center background is a strong plus.)
• Technical Knowledge:
  • Proficiency in CPT, ICD-10, and HCPCS coding specific to GI procedures and office evaluations.
  • Familiarity with major commercial insurance portals, Medicare, and Medicaid guidelines.
  • Experience with Electronic Health Record (EHR) and Practice Management (PM) software.
• Compliance & Ethics: Strict adherence to HIPAA regulations and protected health information (PHI) standards.
• Soft Skills: Strong verbal and written communication skills for dealing with distressed or confused patients; high attention to detail and analytical problem-solving.