Billing and Claims Specialist

Job Summary

We are seeking a detail-oriented Accounts Receivable Billing and Claims Specialist to join our team. In this role, you will oversee and manage the full billing cycle—including claims submission, payment posting, denial management, and A/R follow-up—for Medicare, Medicaid, commercial insurers, and self-pay accounts. You’ll play a key role in ensuring accurate billing, prompt reimbursement, and support for facility staff in understanding insurance processes.

Key Responsibilities

• Create, scrub, and submit claims to Medicare, Medicaid, commercial payers, and other carriers

• Prepare and scrub self-pay claims

• Follow up on unpaid or denied claims with all payers

• Document claim follow-ups and resolution steps in the system

• Post insurance payments and process claim-related adjustments

• Work A/R and generate aging analysis by payer type

• Assist facility managers and staff with billing inquiries and training

• Update patient demographics and insurance info in EHR

• Identify trends in claim denials and educate staff as needed

• Monitor credit balances and initiate refunds when necessary

• Process turnarounds and correct claims transmission issues

• Communicate with the Insurance Manager about payer fee schedules and coding issues

• Ensure compliance with AAPHC financial policies and managed care contracts

• Run and review pending claim reports; escalate issues as needed

• Perform other billing-related duties as assigned

Required Knowledge, Skills, and Abilities

• Strong knowledge of:

  • Medical billing and insurance reimbursement

  • Procedure and diagnosis coding

  • Patient accounting and EHR systems

• Excellent attention to detail and accuracy

• Strong communication and interpersonal skills

• Respect for patient confidentiality

• Ability to handle stressful interactions professionally

Education & Experience

• High school diploma required; some college preferred

• Minimum 1 year of experience in medical billing and coding, with knowledge of medical terminology and payer processes

Work Environment & Physical Demands

• Office environment with frequent phone contact

• May require sitting for extended periods

• Manual dexterity needed for computer and calculator use

• Occasional evening or weekend work

• Frequent interruptions; must handle upset or frustrated callers calmly.