Billing Specialist

Suncoast Center, Inc.; Saint Petersburg (FL); On-site; USD 40,000 - 65,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

EAP

Short-term disability

401k / 403b

Paid time off

Job summary

Suncoast Center, Inc seeks a Medical Billing Specialist to manage outpatient revenue cycle tasks and denials, submit electronic claims, post payments, and rebill denied claims. The role requires knowledge of ICD-10-CM, CPT, HCPCS, and experience with EHR systems. A background check and Florida driver’s license are required.

Minimum one year of outpatient billing experience and familiarity with Medicaid/Medicare are essential, with preference given to those with behavioral health billing exposure.

Qualifications

• Minimum one year of outpatient medical revenue cycle experience.
• Knowledge of ICD-10-CM, CPT and HCPCS.
• Experience with Medicaid/Medicare and third party claims & denials.
• Experience with an EHR system and 837/835 file processing.

Responsibilities

• Submit, track, and reconcile electronic insurance claims.
• Post insurance payments and adjustments accurately and timely.
• Review remittance advice and resolve payment discrepancies.
• Identify, correct, appeal, and rebill denied or unpaid claims.
• Verify insurance coverage and obtain required authorizations.
• Maintain patient demographics and billing information in the EHR.
• Coordinate with clinical staff to ensure billing accuracy and compliance.
• Assist the billing phone line and respond to client inquiries.

Skills

Medical billing

EHR reports

Excel

Claims processing

Authorizations

Communication

Education

Bachelor's degree preferred

Tools

Netsmart AVATAR

Job description

Suncoast Center is where good changes happen.

At Suncoast Center, we provide emotional wellness services to individuals and families. Our employees thrive in an environment where diversity and inclusion are a priority.

Minimum Qualifications: A minimum of one year of outpatient medical revenue cycle experience is required, with preference given to candidates with behavioral health experience. The position is responsible for managing and resolving insurance denials from Medicaid, Medicare, commercial, and managed care payers. Duties include submission of electronic claims, payment posting, review and resolution of error reports, and the correction, appeal, and rebilling of outstanding insurance receivables. The role also involves verifying and obtaining insurance authorizations as required, accurately entering and maintaining patient demographic and billing information, and utilizing EHR reporting to identify and correct service issues that impact billing. Additional responsibilities include management of the billing hotline and client statements, as well as appropriate adjustment of client account ledgers.

Education: Bachelors degree preferred and Medical Billing, HIM, and/or Coding Certification is required.

Experience: One year of experience, working Medicare, Medicaid and third party outpatient insurance claims and denials utilizing an EHR; or in lieu a two year degree in Medical Billing, HIM, or a Billing/Coding certification required. Must possess Knowledge of ICD-10CM, CPT and HCPCS. Prefer experience in Behavioral Health Billing.

Additional Requirements

Must be 21 years of age.

Negative Drug Screening prior to hire and throughout employment.

Clear Criminal Background Check throughout employment with Suncoast Center and local checks prior to hire and annually along with DCF Level II prior to hire and as required by DCF, and Must have valid Florida Driver’s License Motor Vehicle checks prior to hire and annually with acceptable driving record maintained throughout employment along with reliable vehicle, valid registration, and valid vehicle insurance. (Must be in compliance with Florida Laws and Administrative Codes with fingerprinting and determined to be of good moral character).

Working Conditions: Work schedule may vary according to department demands. Work is performed indoors.

Computer Literate: Must be computer literate including Excel spreadsheets, electronic claims processing with 837 and 835 files, website portal navigation, EHR comprehension, Microsoft Outlook. Netsmart AVATAR experience a plus.

Job Duties

• Submit, track, and reconcile electronic insurance claims
• Post insurance payments and contractual adjustments accurately and timely
• Review remittance advice and resolve payment discrepancies
• Identify, correct, appeal, and rebill denied or unpaid claims for Medicaid, Medicare, commercial, and managed care payers
• Verify insurance coverage and obtain required authorizations in accordance with payer requirements
• Maintain accurate patient demographic, insurance, and billing information within the EHR
• Utilize EHR and financial reports to identify and resolve documentation or service issues that impede billing
• Coordinate with clinical and administrative staff to ensure billing accuracy and compliance
• Assist the billing phone line and respond to client billing inquiries professionally and in a timely manner.
• Prepare and distribute client billing statements
• Perform client account and ledger adjustments in accordance with organizational policy and payer guidelines
• Ensure compliance with all applicable regulatory, payer, and confidentiality requirements
• Other duties as assigned

Core Competencies

• The ability to function and operate as a team player, showing dignity and respect for all.
• The ability to comply with all equal employment opportunity and ethical standards and regulations.
• The ability to take direction in a respectful and productive manner from supervisors and managers.
• The ability to work, as scheduled, in a timely fashion, and with an attitude oriented to service.
• The ability to have cordial and professional relationships both within the organization and with vendors, clients and third parties.
• If appropriate, the ability to produce all appropriate paperwork and reports consistent with contractual, state or federal standard, and to prepare and submit such paperwork on a timely basis.
• The ability to understand and comply with Suncoast Center, Inc. policies and procedures.
• The ability to render compassionate care and equal commitment to serve clients in need of healthcare assistance.

Conclusion

• The role of a Medical Biller is crucial in ensuring that healthcare providers are compensated for their services while maintaining clear communication with patients regarding their billing inquiries. This position requires a blend of technical skills, attention to detail, and strong communication abilities to navigate the complexities of medical billing and insurance processes.

Benefits & Perks

Health & Wellness

• Medical, dental, and vision insurance with 0 copy for Teledoc Appointments
• EAP Supports
• Company Paid Basic Life, Accidental Death and Dismemberment, and Long term Disability
• Options to secure additional Life/AD&D as well as short term disability

Work-Life Balance

• Paid time off + 10 company paid holidays

Growth & Development

• Professional development options through our Learning Management System and live trainings

Other Perks

• 403b with up to a 5% company match
• Monthly Social Committee Events

Suncoast Center, Inc is a drug free workplace and follows all federal requirements/regulations related to marijuana use

All positions require a screening through the Clearinghouse. This site was implemented under the directive of House Bill 531 (2025). https://info.flclearinghouse.com/