Medical Billing Specialist – Lead

Full Time
Posted 7 years ago

Job Description:

Responsible for identifying and collecting balances due from third party carriers, submitting charges to insurance carriers, following up on charges submitted to all carriers when appropriate, and writing off bad debt of accounts after approved by the Manager and/or Director. Responsible for gathering and disseminating of information relating to billing and reimbursement as well as implementing policies, procedures, and protocols to facilitate the needs of the organization with billing and reimbursement related issues. Provides training to staffed clinicians as assigned. Assists Manager and/or Director and other departmental personnel as needed. Duties include:

  1. Coordinates and reviews the day-to-day duties with the Manager and/or Director.
  2. Maintains designated percentage of collections as defined by the department Manager and/or Director.
  3. Conducts payment follow-up activities on outstanding patient and insurance accounts.
  4. Prepares client request forms.
  5. Responsible for notifying the Manager or Director of immediate or pending system errors, system problems, insurance plans not paying at the approved rates.
  6. Handles telephone communications.
  7. Responsible for monitoring incoming patient calls.
  8. Responsible for working self-pay accounts, verifying eligibility, and converting the patient visit to the appropriate plans.
  9. Identifies denial trends/patterns and reports these to Director.
  10. Sets up payment plans on self-pay balances.
  11. Ensures all denials are identified and the items are worked to the fullest extent, corrected, re-submitted as applicable, in a timely manner.
  12. Write-off uncollectable accounts after approval from Director.
  13. Directs problem accounts to the appropriate staff member, Manager and/or Director.
  14. Assists in trouble shooting and reporting transmittal problems.
  15. Assists in the training of new employees as instructed by Manager and/or Director.
  16. Corrects and/or re-files denials as appropriate.
  17. Performs other duties as assigned from time to time.



High School Diploma or equivalent GED. Associates Degree from college preferred or certificate from a technical school for billing.



  1. Must have 3+ years of experience working in physician collections
  2. Excellent working knowledge of insurance carriers’ payment regulations including various reimbursement schemes, coinsurance and deductibles, and contractual adjustments
  3. Excellent problem solving skills
  4. Ability to multi-task while maintaining attention to detail
  5. Must have Knowledge of Medicare, Medicaid, managed care and commercial insurances
  6. Working knowledge of HIPAA regulations and compliance
  7. Strong interpersonal and communications skills to be able to work successfully in a team-oriented environment
  8. Must have working knowledge with ICD-10/ICD-9 and CPT coding (minimum 2 years)
  9. Must be able to work with minimal supervision

Job Features

Job CategoryMedical Billing Specialist

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