Medical Billing Specialist: Denials & Reimbursements

Suncoast-Center,-Inc; Saint Petersburg (FL); On-site; USD 35,000 - 55,000; Full time

Benefits offered by this job

Health insurance

Teledoc access

Employee Assistance Program

Life insurance

Disability insurance

403b retirement plan

Paid holidays

Job summary

Suncoast Center is seeking a Medical Billing/Data Entry professional in St. Petersburg to manage outpatient insurance claims, verify coverages, and post payments.

The ideal candidate has at least one year in medical revenue cycle, familiarity with Medicaid/Medicare, and knowledge of ICD-10-CM, CPT, HCPCS. The role requires accurate data entry in EHR systems, strong communication, and attention to regulatory requirements.

Qualifications

• Minimum of one year of outpatient medical revenue cycle experience.
• Experience working Medicaid, Medicare and third-party outpatient claims and denials.
• Knowledge of ICD-10CM, CPT and HCPCS.
• Bachelor's degree preferred; Medical Billing/HIM/Coding certification required.

Responsibilities

• Submit, track, and reconcile electronic insurance claims.
• Post insurance payments and contractual adjustments accurately and timely.
• Review remittance advice and resolve payment discrepancies.
• Identify, correct, appeal, and rebill denied or unpaid claims for Medicaid, Medicare, commercial, and managed care payers.
• Verify insurance coverage and obtain required authorizations in accordance with payer requirements.
• Maintain accurate patient demographic, insurance, and billing information within the EHR.
• Utilize EHR and financial reports to identify and resolve documentation or service issues that impede billing.
• Coordinate with clinical and administrative staff to ensure billing accuracy and compliance.
• Assist the billing phone line and respond to client billing inquiries professionally and in a timely manner.
• Prepare and distribute client billing statements.
• Perform client account and ledger adjustments in accordance with organizational policy and payer guidelines.
• Ensure compliance with all applicable regulatory, payer, and confidentiality requirements.
• Other duties as assigned

Skills

Billing experience

Denials management

Insurance verification

EHR proficiency

Teamwork

Education

Bachelor's degree preferred

Medical Billing/HIM/Coding Certification required

Tools

Excel

Electronic claims processing (837/835)

EHR systems (Netsmart AVATAR)

Website portal navigation

Microsoft Outlook

EHR comprehension

Job description

Suncoast Center is seeking a Medical Billing/Data Entry professional in St. Petersburg to manage outpatient insurance claims, verify coverages, and post payments.

The ideal candidate has at least one year in medical revenue cycle, familiarity with Medicaid/Medicare, and knowledge of ICD-10-CM, CPT, HCPCS. The role requires accurate data entry in EHR systems, strong communication, and attention to regulatory requirements.