Pediatric Medical Billing & AR Specialist

Thinkkids; Houston (TX); On-site; USD 42,000 - 66,000; Full time

Job summary

THINK Neurology for Kids in Houston, TX is seeking an Insurance and Billing Specialist to support the full revenue cycle in a pediatric neurology practice. You will manage claim submissions, AR follow-up, denial management, and posting payments using ECW and Waystar, while ensuring accurate documentation and compliance.

The role requires knowledge of payer requirements, ICD-10-CM, CPT, and HCPCS coding, with attention to detail and the ability to work independently and with a team to maximize

Qualifications

• High school diploma or equivalent required.
• Medical Billing and Coding coursework preferred.
• Minimum one year of medical billing, accounts receivable, or revenue cycle experience preferred.
• Experience with electronic health records and practice management systems; eClinicalWorks experience strongly preferred.
• Experience with clearinghouse systems and electronic claims submission; Waystar experience preferred.
• Working knowledge of ICD-10-CM, CPT, and HCPCS coding.
• Understanding of commercial insurance, Medicaid, and managed care plans.
• Pediatric specialty billing experience preferred.

Responsibilities

• Review and verify completed encounters for billing readiness.
• Submit electronic claims through ECW and Waystar in a timely manner.
• Monitor claim status and correct claim edits, rejections, and clearinghouse errors.
• Ensure claims meet payer-specific requirements prior to submission.
• Assist with medical record and documentation attachment workflows when required by payers.
• Manage assigned accounts receivable work queues and aging accounts.
• Follow up on unpaid claims through payer portals, phone calls, correspondence, and online resources.
• Prioritize aging balances, including claims exceeding 90, 120, and 180 days.
• Investigate claim delays, medical records requests, coordination of benefits issues, and eligibility concerns.
• Document all collection efforts and payer communications within ECW.
• Review insurance denials and identify trends affecting reimbursement.
• Prepare and submit corrected claims, reconsiderations, and appeals with supporting documentation.
• Research payer policies, coding requirements, medical necessity guidelines, and billing regulations to support appeals.
• Collaborate with management and providers to address recurring denial patterns.
• Post insurance and patient payments accurately and timely.
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs).
• Process payment adjustments in accordance with payer contracts and practice policies.
• Participate in daily reconciliation of posted payments, deposits, and bank activity.
• Assist with the preparation and maintenance of daily reconciliation reports and supporting documentation.
• Assist patients with billing questions and account balances.
• Discuss payment options and payment arrangements consistent with practice policies.
• Generate and monitor patient statements.
• Communicate professionally and compassionately with families regarding financial responsibilities.
• Perform patient outreach related to coordination of benefits, demographic updates, and insurance-related corrections.
• Document all outreach attempts in accordance with departmental procedures.
• Assist in resolving eligibility, subscriber information, and coverage discrepancies.
• Identify workflow issues affecting reimbursement and recommend process improvements.
• Participate in billing meetings, training, and revenue cycle initiatives.
• Maintain knowledge of payer updates, regulatory changes, coding guidelines, and reimbursement trends.
• Assist with cleanup of aging accounts, legacy balances, credit balances, and special projects as assigned.
• Maintain accurate and complete documentation of all billing activities.
• Follow HIPAA and patient confidentiality requirements.
• Comply with all payer, federal, state, and organizational billing regulations.
• Adhere to established department policies, standard operating procedures, and quality standards.
• Performance expectations include timely submissions, accurate postings, active AR management, and denial resolution.

Skills

Revenue Cycle

Analytical Skills

Attention to Detail

Time Management

Communication

Claims Submission

AR Follow-Up

Denials & Appeals

Payment Posting

Patient Billing

COB & Verification

Process Improvement

Documentation & Compliance

Education

High School Diploma

Medical Billing/Coding Coursework

Tools

eClinicalWorks

Waystar

Job description

THINK Neurology for Kids in Houston, TX is seeking an Insurance and Billing Specialist to support the full revenue cycle in a pediatric neurology practice. You will manage claim submissions, AR follow-up, denial management, and posting payments using ECW and Waystar, while ensuring accurate documentation and compliance.

The role requires knowledge of payer requirements, ICD-10-CM, CPT, and HCPCS coding, with attention to detail and the ability to work independently and with a team to maximize