Billing Specialist

HOPCo; Phoenix (AZ); On-site; USD 45,000 - 60,000; Full time

Job summary

HOPCo is seeking a detail-oriented Medical Billing Specialist to maintain productivity metrics, review claim rejections, and ensure accurate submissions to insurance carriers. You will verify patient demographics, eligibility, and coordination of benefits, while assisting with payer enrollments and EDI processes.

Ideal candidates have 2–3 years in medical billing, familiarity with ERA/EFT enrollments, and knowledge of ICD-10, CPT, and HCPCS codes.

Qualifications

• Minimum 2–3 years of medical billing experience.
• Experience handling claim errors in a claims management system.
• Knowledge of ICD-10, HCPCS, and CPT codes.

Responsibilities

• Maintain productivity and accuracy metrics per department expectations.
• Process clean claims and ensure timely submission to insurance carriers.
• Review insurance rejections and determine next steps to resolve them.
• Correct and resubmit billing errors to insurance carriers.
• Verify patient demographics and insurance eligibility including coordination of benefits.
• Identify trends or issues and communicate with management.
• Maintain Athena master files including provider information and payer enrollments.
• Handle EDI, ERA and EFT enrollments for all payers.

Skills

Medical billing

Attention to detail

Rejection resolution

Process tracking

Education

High school diploma or GED

Tools

Athena billing system

EDI enrollment processes

ANSI formatting

Payer enrollment platforms

Job description

• Maintains productivity and accuracy metrics per department expectations.
• Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers.
• Reviews insurance rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding rejections.
• Correct and identify billing errors and resubmit claims to insurance carriers.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Assist in identifies and communicating trends and/or potential issues to management team.
• Payer website user access maintenance.
• Responsible for system maintenance of Athena master files including referring provider information, accurate insurance plan information and payer enrollments.
• Responsible for EDI, ERA and EFT enrollments for all payers.

EDUCATION

• High school diploma or GED

EXPERIENCE

• Minimum two to three years of experience in medical billing. Experienced candidates will have prior experience working claim errors in a claims management system. Prefer candidates with knowledge of ERA/EFT enrollment as well as ANSI formatting.

REQUIREMENTS

• Requires demonstrated knowledge of revenue cycle applications. Prefer prior experience configuring revenue cycle vendor-supplied software.

KNOWLEDGE

• Knowledge of ICD-10, HCPS, and CPT codes, medical terminology, and billing practices.
• Advanced computer knowledge, including Window based programs.

Equal Opportunity Employer
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