Medical Billing and Claims Specialist

PEDIATRIC CARDIOLOGY CONSULTANTS OF SOUTH TEXAS; Texas; On-site; USD 35,000 - 45,000; Full time

Benefits offered by this job

Bonus based on performance

Opportunity for advancement

Paid time off

Job summary

A healthcare clinic in Texas is seeking a full-time Billing and Claims Specialist to manage patient accounts, verify insurance, and handle billing tasks. The ideal candidate will provide excellent customer service, ensuring a positive experience while managing front desk duties, authorization processes, and billing claims through Athena EMR. Applicants should have a high school diploma and experience in a medical front office, along with strong communication and organizational skills.

Qualifications

• High school diploma or equivalent; additional education in healthcare administration or billing is a plus.
• Experience in a medical front office role is preferred.
• Proficiency with billing and claims management.
• Strong understanding of insurance verification and prior authorizations.

Responsibilities

• Greet and check in patients, managing their records efficiently.
• Verify insurance coverage and confirm eligibility for appointments.
• Manage billing processes and handle claims using Athena EMR.
• Answer phone calls and respond to patient inquiries accurately.

Skills

Customer service

Insurance verification

Claims processing

Organizational skills

Attention to detail

Communication skills

Education

High school diploma or equivalent

Education in healthcare administration

Tools

Athena EMR

Job description

Benefits:

• Bonus based on performance
• Opportunity for advancement
• Paid time off
• Location: Pediatric Cardiology Consultants of South Texas (PCCST)

Job Summary:

The Billing and claims Specialist will play a critical role in managing the administrative and financial aspects of patient visits. The ideal candidate will provide excellent customer service, manage patient check-in/check-out, prior authorizations and handle billing tasks. This role also requires a detail-oriented individual who can manage patient accounts, verify insurance, and ensure the timely processing of claims and payments.

Key Responsibilities:

• Front Desk Duties:
  • Greet patients warmly and ensure a positive and professional experience.
  • Manage patient check-in and check-out processes efficiently.
  • Schedule patient appointments and follow-ups based on physician availability and patient needs.
  • Maintain the reception area, keeping it clean, organized, and welcoming.
• Patient Information & Account Management:
  • Update and maintain patient demographics by collecting personal and financial information.
  • Verify insurance coverage and confirm eligibility prior to patient appointments.
  • Explain insurance coverage to patients, including out-of-pocket costs, co-pays, and deductibles.
  • Collect outstanding balances, co-pays, deductibles, and previous balances as needed.
• Billing & Insurance Processing:
  • Manage billing processes and send claims to insurance companies using EMR (Athena).
  • Handle prior authorizations and ensure all required documentation is submitted accurately.
  • Communicate with insurance payers to ensure timely processing of claims and resolution of issues.
  • Post charges, collections, and payments into the computer system and close daily batches.
  • Monitor and follow up on unpaid claims, denials, or payment discrepancies to ensure timely reimbursement.
  • Provide patients with detailed explanations of their bills, including procedures not covered by insurance.
• General Administrative Duties:
  • Answer incoming phone calls, manage emails, and respond to patient inquiries regarding appointments, billing, or general clinic information.
  • Assist in coordinating care with physicians, MAs, nurses, and other clinic staff.
  • Ensure all patient documentation is completed accurately and filed appropriately.
  • Participate in daily, weekly, or monthly meetings to review clinic operations, billing, and patient satisfaction metrics.

Qualifications:

• High school diploma or equivalent; additional education in healthcare administration or billing is a plus.
• Experience in a medical front office role
• Experience with Athena EMR is a plus
• Proficiency with billing, and claims management.
• Strong understanding of insurance verification, prior authorizations, and claims processing.
• Excellent communication and interpersonal skills with a patient-centric approach.
• Strong organizational skills and attention to detail.
• Ability to handle confidential information with professionalism.

Job Type: Full-time

Schedule:

• 8 hour shifts
• Monday to Friday

Education:

High school diploma or higher