Medical Billing Specialist

Banyan Health; Miami (FL); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

100% Paid Health Insurance (Employee)

Employer-paid basic life insurance

Dental, Vision, STD, LTD

403(b) retirement plan with employer-m

Student loan forgiveness opportunities

HRSA loan repayment program (eligible)

Job summary

Banyan Health is seeking an experienced RCM Billing Specialist to oversee the billing of all charges across multiple service lines in a hospital/health system setting. You will triage complex claim issues, monitor AR trends, and ensure compliant, timely reimbursements from Medicare, Medicaid and other payers.

Responsibilities include daily claim submissions, error resolution, patient account updates, and collaboration with RCM leadership to optimize processes and outcomes.

Qualifications

• Strong knowledge of medical billing, payer guidelines, and benefits across multiple payers.
• Experience with Medicare/Medicaid and commercial plans is expected.
• Ability to triage complex claim issues and AR trends.
• Familiarity with CPT and ICD-10 codes and insurance terminology.
• Proven ability to meet deadlines and manage high-volume workflows.

Responsibilities

• Batch and submit claims daily to clearinghouse and payers for timely charges.
• Review errors/rejections and resubmit claims for payment.
• Update patient accounts to correct information (demographics, eligibility dates, etc.).
• Manage workflow of assigned accounts and deadlines for max reimbursements.
• Document all system updates for follow-up work.
• Audit trends due to configuration issues in practice management or clearinghouse.
• Research payer policies and communicate findings to RCM management.
• Maintain knowledge of applicable laws and health system policies.
• Assist with month-end projects and respond to inquiries within 1 business day.
• Identify AR trends and participate in RCM department projects.

Skills

Medical terminology

Insurance guidelines

Billing & AR management

Clearinghouse processes

Payer communication

CPT/ICD-10 knowledge

Regulatory compliance

Analytical trend analysis

Education

Associate degree preferred

Job description

Reporting to the RCM Manager, this position will be responsible for the billing of all Banyan charges including but not limited to all inpatient and outpatient service lines. This includes multiple specialties and the ability to triage complex claim issues and AR trends. In addition, this role will also need to have extensive knowledge of billing, payer guidelines, clearinghouse functions, and benefit eligibility and coverage through multiple payers including Medicare and Medicaid, and a strong foundational knowledge of revenue cycle management. Supports the success of a high-performing shared services organization by helping to champion and drive the long-term Health System Shared Services vision. Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized.

Responsibilities

• Batching and submitting claims on a daily basis to the clearinghouse and payers to ensure timely submission of charges.
• Reviewing errors and rejections by clearinghouse and payers daily to resubmit claims for payment.
• Updating all patient accounts to correct inaccurate information i.e. demographics, eligibility dates, termination dates, and contract allowance and/or maximum.
• Managing the workflow of assigned accounts and meeting deadlines for filing to obtain maximum reimbursements.
• Ability to properly update and document all systems according to follow-up work.
• Audit and investigate any trends due to configuration issues within the Practice Mgmt System or clearinghouse.
• Ability to research payer policies, claim issues, and communicate to RCM management.
• Maintains knowledge of applicable Federal, State, and local laws and regulations, Standards of Conduct, as well as Health System policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
• Knowledge of payor benefits and coverage including Medicare, Medicaid, Managed Care, Commercial, and Dual plans.
• Ability to multi-task and meet weekly and monthly deadlines.
• Assist in month end projects and processes.
• Respond to all inquiries from patients, physicians or departmental customers (both internal and external) within 1 business day of initial request.
• Identify, report, and communicate accounts receivable trends to RCM management.
• Small- and large-scale projects for the RCM department.

Education

Associate degree preferred. Work experience may substitute degree (i.e., 2 years of experience for 1 year of education)

Knowledge

• Advanced knowledge of medical and insurance terminology
• Advanced Knowledge and demonstrated proficiency in medical insurance plans, billing and regulations, and manage care plans.
• Strong ability to multi-task and work under pressure to meet deadlines.
• Medical insurance collections experience in a healthcare setting.
• Working knowledge of applicable Federal, State, and local laws and regulations desired
• Working knowledge of CPT and ICD-10 codes as they relate to financial clearance.
• Able to obtain payer specific details, as necessary, to ensure accurate coordination of benefits.
• Experience working with multiple payer websites and portals.

Work Experience

• Minimum 2-3 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience
• Experience in behavioral health billing and/or collections preferred.

Job Type: Full-time

100% Paid Health Insurance (Employee Base Plan)

100% Employer-Paid Basic Life Insurance

Dental, Vision, Short-Term Disability (STD), Long-Term Disability (LTD), Secondary Health Insurance, and Other Voluntary Benefit Plans

403(b) Retirement Plan with Employer Matching

Student Loan Forgiveness Opportunities

Potential HRSA Student Loan Repayment for eligible licensed positions*

*Certain licensed positions working in qualifying outpatient settings may be eligible for the HRSA National Health Service Corps Loan Repayment Program. Eligibility is subject to HRSA requirements and position responsibilities and will be confirmed during the hiring process.