CPC-Certified Billing Specialist: Claims & Denials Expert

OHI - Ocean Health Initiatives, Inc.; Brick Township (NJ); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Health insurance

401(k) matching

Paid time off

Paid holidays

Flexible spending accounts

Employee discounts

Employee referral program

CME

Voluntary life insurance

Job summary

Ocean Health Initiatives, Inc. is seeking a Billing Specialist to ensure timely and accurate submission of claims, follow-up on reimbursements, and denial management. Reporting to the Billing Manager, you will monitor payer trends and ensure compliance with MCO requirements.

You will participate in CQI initiatives, stay current with billing regulations, educate providers on documentation, and collaborate to resolve issues, with a focus on improving cash flow and KPI performance.

Qualifications

• High School diploma or equivalent required.
• CPC certification required for all CPCs.
• Healthcare billing experience: 1–2 years in a billing department.
• Bi-lingual English/Spanish preferred.
• Proficiency in Microsoft Office 365 required.

Responsibilities

• Submit claims to payers in a timely and accurate manner.
• Review coder documentation for alignment with guidelines and escalate discrepancies.
• Stay informed about MCO changes and billing requirements to ensure compliance.
• Manage payer denials by reviewing, correcting, and resubmitting claims.
• Monitor aging reports and follow up with patients and insurers to resolve issues.
• Post payments, adjust contracts, and handle patient refunds as needed.
• Provide excellent customer service for billing inquiries from patients and insurers.
• Contribute to CQI committee with billing process improvements.
• Collaborate with Billing Manager to track payer trends and improve resolution times.
• Maintain proficiency in Billing Platform and EMR systems for error-free claims processing.
• Ensure compliance with federal, state, and MCO regulations to maximize reimbursement.
• Meet KPIs for billing efficiency and denials management.
• Assist with manual charge input and other billing tasks.
• Participate in training to stay current with billing policies and procedures.
• Use claims scrubbers to identify and correct errors before submission.
• Educate providers on proper documentation to align with coding and payer guidelines.

Skills

Billing knowledge

Claims submission

Denial management

Customer service

Payer communication

Microsoft Office 365

Education

CPC certification

High School diploma

Bilingual English/Spanish

Tools

Billing Platform

EMR systems

Job description

Ocean Health Initiatives, Inc. is seeking a Billing Specialist to ensure timely and accurate submission of claims, follow-up on reimbursements, and denial management. Reporting to the Billing Manager, you will monitor payer trends and ensure compliance with MCO requirements.

You will participate in CQI initiatives, stay current with billing regulations, educate providers on documentation, and collaborate to resolve issues, with a focus on improving cash flow and KPI performance.