Billing Specialist

Evolving Solution Services; Saint Petersburg (FL); On-site; USD 42,000 - 62,000; Full time

Job summary

Evolving Solution Services seeks a Medical Billing Specialist to support a pediatric urgent care practice in St. Pete, Florida. The role focuses on accurate coding, claim submission, and follow-up to maximize timely reimbursement while complying with Medicaid requirements.

Responsibilities include reviewing provider documentation, billing CPT/ICD-10/HCPCS codes, managing Medicaid claims, and resolving denials. Team-oriented environment with high-volume workflow.

Qualifications

• Minimum 2 years of medical billing experience in urgent care, emergency, or pediatric settings.
• Strong Medicaid and managed Medicaid billing experience.
• Solid understanding of urgent care E/M coding, procedure coding, and modifiers.
• Experience with EHR/EMR and practice management systems.
• Ability to work accurately in a fast-paced, high-volume environment.

Responsibilities

• Review urgent care provider documentation and assign CPT, ICD-10, and HCPCS codes
• Bill services including E/M levels, minor procedures, splinting, laceration repair, and diagnostic services
• Submit and manage claims for Medicaid and Medicaid MCOs, with some commercial payers
• Apply correct modifiers for urgent care services, procedures, and multiple services in a single visit
• Verify Medicaid eligibility, managed care enrollment, and urgent care coverage rules
• Identify, research, and resolve denials related to medical necessity, bundling, modifiers, frequency limits, and timely filing
• Prepare and submit corrected claims and appeals according to state Medicaid guidelines
• Post payments, contractual adjustments, and reconcile ERAs/EOBs
• Monitor accounts receivable, track claim aging, and prioritize timely follow-up
• Work closely with clinical and front-office teams to resolve documentation, registration, or coding issues

Skills

Medical billing

Medicaid billing

E/M coding

CPT coding

ICD-10 coding

HCPCS coding

EHR/EMR

Practice management

Denial management

Time management

Payer communication

Tools

EHR/EMR

Practice management systems

Job description

Location: This position is located in office in St. Pete, Florida. This is not a remote job.

The Medical Billing Specialist supports a high-volume pediatric urgent care practice with a strong Medicaid and managed Medicaid payer mix. This role is responsible for accurate coding, claim submission, and follow-up for episodic urgent care visits, procedures, and ancillary services, ensuring timely reimbursement while maintaining compliance with Medicaid and payer-specific requirements.

Key Responsibilities

• Review urgent care provider documentation and assign accurate CPT, ICD-10, and HCPCS codes


• Bill high-volume pediatric urgent care services, including E/M levels, minor procedures, splinting, laceration repair, and diagnostic services


• Submit and manage claims primarily for Medicaid and Medicaid MCOs, with some commercial payers


• Apply correct modifiers for urgent care services, procedures, and multiple services rendered in a single visit


• Verify Medicaid eligibility, managed care enrollment, and urgent care coverage rules


• Identify, research, and resolve denials related to medical necessity, bundling, modifiers, frequency limits, and timely filing


• Prepare and submit corrected claims and appeals in accordance with state Medicaid guidelines


• Post payments, contractual adjustments, and reconcile ERAs/EOBs


• Monitor accounts receivable, track claim aging, and prioritize timely follow-up


• Work closely with clinical and front-office teams to resolve documentation, registration, or coding issues

Qualifications

• Minimum 2 years of medical billing experience in urgent care, emergency, or pediatric physician practice settings


• Strong experience with Medicaid and managed Medicaid billing


• Solid understanding of urgent care E/M coding, procedure coding, and modifier usage


• Experience with EHR/EMR and practice management systems


• Ability to work accurately in a fast-paced, high-volume environment

Preferred Certifications

• Certified Professional Biller (CPB)


• Certified Medical Reimbursement Specialist (CMRS)


• Urgent care or pediatric billing experience strongly preferred


• Knowledge of Medicaid urgent care policies and payer-specific edits


• Strong denial management and appeal skills


• High attention to detail with excellent time-management


• Clear communication with payers, providers, and operational staff


• Commitment to compliance, accuracy, and patient confidentiality