Medical Billing Specialist

Pain Treatment Centers of America; United States; Remote; USD 52.000 - 75.000; Vollzeit

Benefits dieser Stelle

Work from home option

Flexible schedule

Zusammenfassung

Pain Treatment Centers of America seeks a detail-oriented Medical Billing Specialist with strong medical billing, coding, and insurance experience. You will submit claims, code procedures, and generate cost estimates while ensuring accuracy in EHR/EMR systems such as Epic, Meditech, and PrognoCis.

The role requires knowledge of ICD-10, CPT, HCPCS and payer guidelines, with responsibility for denials, appeals, and patient inquiries. A work-from-home option may be available based on experience.

Qualifikationen

• Minimum 2 years of experience in medical billing, coding, insurance follow-up and working within EHR/EMR systems.
• Strong knowledge of ICD-10, CPT, and HCPCS coding systems.
• Experience creating cost estimates for procedures.
• Familiarity with payer reimbursement guidelines and HIPAA regulations.

Aufgaben

• Accurately process and submit medical claims to insurance companies and government payers.
• Perform medical coding using ICD-10, CPT, and HCPCS standards.
• Generate and communicate cost estimates for procedures based on coverage and contracts.
• Review billing data in EHR/EMR systems prior to claim submission.
• Use EHR/EMR platforms (Epic, Meditech, PrognoCis) for documentation and billing workflows.
• Research and resolve billing discrepancies or claim denials.
• Prepare and submit insurance appeals per payer guidelines.
• Communicate billing questions to patients and explain coverage and responsibilities.
• Maintain up-to-date knowledge of terminology, payer requirements, and regulations (HIPAA, CMS).
• Collaborate with clinical staff to ensure accurate coding and documentation.
• Track accounts receivable and follow up on outstanding claims.

Kenntnisse

Medical billing

Medical coding

Insurance follow-up

Payer communications

HIPAA compliance

Attention to detail

Communication skills

Ausbildung

Associate's degree in Healthcare Administration, Billing & Coding

CPC certification

CCS certification

High school diploma

Tools

Epic

Meditech

PrognoCis

Jobbeschreibung

We are seeking a detail-oriented and experienced Medical Billing Specialist with a strong background in medical billing, coding, and insurance processes. The ideal candidate will be skilled in medical terminology, procedure coding, cost estimation, insurance appeals, and working within electronic health record systems. This role requires accuracy, excellent communication skills, and the ability to work with both patients and payers to ensure timely and correct reimbursement.

This position may offer the opportunity to work from home, depending on experience and performance.

Key Responsibilities

• Accurately process and submit medical claims to insurance companies, government payers, and other third-party organizations.
• Perform medical coding using ICD-10, CPT, and HCPCS standards for a variety of procedures and diagnoses.
• Generate and communicate cost estimates for procedures based on insurance coverage and contract agreements.
• Review and verify accuracy of billing data within EHR/EMR systems prior to claim submission.
• Utilize EHR/EMR platforms (such as Epic, Meditech, PrognoCis) for documentation, coding, and billing workflows.
• Research and resolve billing discrepancies or claim denials.
• Prepare and submit insurance appeals, ensuring compliance with payer guidelines.
• Communicate with patients regarding billing questions, payment responsibilities, and insurance coverage.
• Maintain up-to-date knowledge of medical terminology, payer requirements, and compliance regulations (HIPAA, CMS, etc.).
• Collaborate with clinical staff and providers to ensure accurate coding and documentation within electronic systems.
• Track accounts receivable and follow up on outstanding claims to maximize revenue.

Requirements

• High school diploma or equivalent required; Associate's degree in Healthcare Administration, Billing & Coding, or related field preferred.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification strongly preferred.
• Minimum of 2 years of experience in medical billing, coding, insurance follow-up, and working within EHR/EMR systems.
• Strong knowledge of ICD-10, CPT, and HCPCS coding systems.
• Hands-on experience with electronic health record (EHR) and electronic medical record (EMR) systems, including Epic, Meditech, and/or PrognoCis.
• Familiarity with medical terminology, payer reimbursement guidelines, and healthcare regulations.
• Experience creating cost estimates for medical procedures.
• Skilled in preparing and submitting appeals for denied claims.
• Proficiency with medical billing software and electronic health record (EHR) systems.
• Strong attention to detail, problem-solving, and organizational skills.
• Excellent written and verbal communication skills.

Preferred Skills

• Experience with Medicare/Medicaid billing and commercial insurance.
• Advanced knowledge of EHR/EMR workflows and system navigation.
• Ability to work independently and manage multiple tasks in a fast-paced environment.
• Customer service experience in a healthcare setting.