Billing Specialist: Claims & Denials Expert

Ocean Health Initiatives; Brick Township (NJ); On-site; USD 42,000 - 64,000; Full time

Job summary

Ocean Health Initiatives in Brick, NJ is seeking a Billing Specialist to ensure timely and accurate submission of claims, follow-up on reimbursements, and effective denial management. Reporting to the Billing Manager, you will monitor payer trends and stay updated on MCO billing requirements while contributing to CQI initiatives to maintain compliance.

You will need strong communication with patients and providers, proficiency in Billing platforms and EMR systems, and a commitment to KPI targets

Qualifications

• High School diploma or equivalent required.
• One to two years’ experience in Healthcare or Call Center setting.
• Bilingual in Spanish and English preferred.
• Clinical certification (CMA, LPN, RN) preferred.
• Proficiency in Microsoft Office 365 is required.
• Certification: CPC is required for all CPCs.
• Medical Billing Certification is preferred or relevant years of experience.
• One to two years of experience in a billing department, medical center, private physician’s office, or other applicable healthcare setting is required.
• One to two years of experience in a Federally Qualified Health Center is preferred.

Responsibilities

• Ensure timely submission of claims to payers per guidelines.
• Review coder documentation for alignment with guidelines.
• Stay updated with MCO changes to billing requirements.
• Manage payer denials and resubmissions.
• Post payments and handle patient refunds.
• Meet KPIs for billing efficiency and denials management.
• Educate providers on documentation practices.
• Assist with manual charge input.
• Monitor aging reports and collect on delinquent accounts.

Skills

Bilingual English/Spanish

Education

High School diploma or equivalent

CPC certification

Medical Billing Certification

Clinical certification (CMA/LPN/RN) preferred

Tools

Billing Platform

EMR systems

Microsoft Office 365

Job description

Ocean Health Initiatives in Brick, NJ is seeking a Billing Specialist to ensure timely and accurate submission of claims, follow-up on reimbursements, and effective denial management. Reporting to the Billing Manager, you will monitor payer trends and stay updated on MCO billing requirements while contributing to CQI initiatives to maintain compliance.

You will need strong communication with patients and providers, proficiency in Billing platforms and EMR systems, and a commitment to KPI targets