Medical Billing Specialist

DaMar Staffing; Johnstown (Cambria County); On-site; USD 45,000 - 65,000; Full time

Job summary

Lifeline Medical is a mission-driven organization delivering medical and behavioral health services to improve access and outcomes. This role focuses on comprehensive outpatient billing, coordinating benefits, managing denials, and ensuring accurate claims across commercial, Medicare, and Medicaid payer streams.

Seeking a highly dependable, detail-oriented individual with 5+ years of full-cycle medical billing experience, including PCP billing.

Qualifications

• 5+ years of outpatient medical billing experience is REQUIRED.
• Experience with mental/behavioral health and primary care billing.
• Full-cycle billing experience required.
• References available to verify billing experience and performance.
• Billing knowledge assessment may be required during interview.
• Experience with commercial insurance, Medicare, Medicaid, and managed care plans.
• Strong understanding of CPT, HCPCS, ICD-10-CM and payer billing requirements.
• Experience with denials, rejections, unpaid claims and aging accounts.
• Experience with electronic claims, clearinghouses, payer portals, and EHR/PM systems.
• Ability to independently research and resolve billing problems.
• Primary care billing experience.

Responsibilities

• Verify patient insurance eligibility and benefits.
• Confirm coverage and payer information prior to billing.
• Verify coordination of benefits (COB).
• Identify primary, secondary, and tertiary insurance.
• Review patient demographics and insurance information for accuracy.
• Review provider documentation for billing readiness.
• Review CPT, HCPCS, ICD-10-CM, modifiers, units, place of service, and other claim information.
• Identify missing or inconsistent billing information before claims are submitted.
• Prepare and submit clean electronic and paper claims.
• Submit primary and secondary claims.
• Correct clearinghouse and payer claim rejections.
• Monitor claim acceptance reports.
• Track claims through adjudication.
• Review EOBs and ERAs.
• Post insurance payments and adjustments.
• Post patient payments when assigned.
• Review contractual adjustments.
• Identify incorrect payments and underpayments.
• Follow up on unpaid and delayed claims.
• Work insurance aging reports.
• Work accounts receivable (A/R) by payer and aging category.
• Research claims through payer portals and telephone follow-up.
• Correct and resubmit claims when appropriate.
• Prepare corrected and replacement claims.
• Identify and resolve timely-filing issues.
• Work denied claims from initial denial through resolution.
• Research denial reasons and determine appropriate corrective action.
• Prepare and submit reconsiderations and appeals.
• Follow up on submitted appeals.
• Obtain claim status and document all follow-up activity.
• Review authorization-related denials and billing issues.
• Identify credentialing or enrollment-related claim problems and elevate appropriately.
• Research payer policies and billing requirements.
• Work recoupments, take-backs, and overpayment notices as assigned.
• Assist with payer requests for records and billing information.
• Reconcile payments and identify missing ERAs/EOBs.
• Maintain accurate billing notes and account documentation.
• Communicate billing issues to providers, management, and other departments.
• Identify recurring billing problems and immediately bring them to management's attention.
• Assist with month-end billing and A/R reconciliation.
• Maintain organized follow-up lists and meet billing deadlines.

Skills

Medical billing

Behavioral health billing

Primary care billing

Full-cycle billing

Denials management

Payer communications

Research skills

Attention to detail

Education

High school diploma or GED

Medical Billing and Coding certification

Tools

Electronic claims systems

Payer portals

EHR/PM systems

Clearinghouses

Job description

Lifeline Medical is a mission-driven medical and behavioral health organization dedicated to improving access to high-quality, compassionate health care. We provide evidence-based clinical services designed to support individuals across the full continuum of physical, emotional, psychological, and behavioral needs. Our team of licensed providers delivers care that is patient-centered, outcomes-focused, and grounded in clinical integrity. By combining modern care delivery models with a human-first approach, we create an environment where patients feel safe, supported, and empowered to achieve lasting stability and improved quality of life. At Lifeline Medical, we are committed to removing barriers to care, strengthening communities, and setting a higher standard for accessible and ethical mental healthcare.

Job Duties

• Verify patient insurance eligibility and benefits
• Confirm coverage and payer information prior to billing
• Verify coordination of benefits (COB)
• Identify primary, secondary, and tertiary insurance
• Review patient demographics and insurance information for accuracy
• Review provider documentation for billing readiness
• Review CPT, HCPCS, ICD-10-CM, modifiers, units, place of service, and other claim information
• Identify missing or inconsistent billing information before claims are submitted
• Prepare and submit clean electronic and paper claims
• Submit primary and secondary claims
• Correct clearinghouse and payer claim rejections
• Monitor claim acceptance reports
• Track claims through adjudication
• Review EOBs and ERAs
• Post insurance payments and adjustments
• Post patient payments when assigned
• Review contractual adjustments
• Identify incorrect payments and underpayments
• Follow up on unpaid and delayed claims
• Work insurance aging reports
• Work accounts receivable (A/R) by payer and aging category
• Research claims through payer portals and telephone follow-up
• Correct and resubmit claims when appropriate
• Prepare corrected and replacement claims
• Identify and resolve timely-filing issues
• Work denied claims from initial denial through resolution
• Research denial reasons and determine appropriate corrective action
• Prepare and submit reconsiderations and appeals
• Follow up on submitted appeals
• Obtain claim status and document all follow-up activity
• Review authorization-related denials and billing issues
• Identify credentialing or enrollment-related claim problems and elevate appropriately
• Research payer policies and billing requirements
• Work recoupments, take-backs, and overpayment notices as assigned
• Assist with payer requests for records and billing information
• Reconcile payments and identify missing ERAs/EOBs
• Maintain accurate billing notes and account documentation
• Communicate billing issues to providers, management, and other departments
• Identify recurring billing problems and immediately bring them to management's attention
• Assist with month-end billing and A/R reconciliation
• Maintain organized follow-up lists and meet billing deadlines

Education

• High school diploma or GED required.
• Medical Billing and Coding certification

Qualification

• 5+ years of outpatient medical billing experience is REQUIRED.
• Candidates must have both mental/behavioral health and primary care billing experience.
• Experience must include full-cycle billing
• Applicants should be prepared to provide professional references that can verify their billing experience and performance.
• A billing knowledge assessment may be required during the interview process.
• Experience working with commercial insurance, Medicare, Medicaid, and managed care plans
• Strong understanding of CPT, HCPCS, ICD-10-CM, modifiers, and payer billing requirements
• Experience working denials, rejections, unpaid claims, and aging accounts
• Experience with electronic claims, clearinghouses, payer portals, and EHR/practice management systems
• Ability to independently research and resolve billing problems
• Primary care (PCP) billing experience

Skill

• Extremely dependable
• Highly responsive
• Detail-oriented and accurate
• Organized and productive
• Comfortable working independently
• Able to prioritize a large workload
• Able to research answers instead of waiting to be told what to do
• Persistent with insurance follow-up
• Comfortable communicating directly with insurance companies
• Able to recognize when something does not look correct
• Willing to elevate significant billing concerns immediately

Mental Health Billing Experience

Applicants should have strong familiarity with outpatient behavioral health billing, including:

• Psychiatric diagnostic evaluations
• Psychiatric medication management
• Psychotherapy
• Psychotherapy provided with E/M services
• Individual and family therapy
• Behavioral health assessments```. Actually we need to correct the list. I'll finish.`