Join our clinic as a Billing Administrator, a pivotal role responsible for managing our revenue cycle with the highest degree of integrity and professionalism. Your accurate and timely processing of insurance claims and effective management of billing operations are essential for maintaining the clinic's financial health, thereby allowing our patients to focus entirely on their recovery and care.

Job Description

The Billing Administrator is the key individual responsible for the accurate and efficient handling of all patient billing, insurance claims submissions, and accounts receivable management. You will serve as the liaison between the clinic, patients, and various third-party payers (insurance companies, government programs), ensuring compliance with complex billing rules and maximizing clean claim submission rates to maintain a smooth and effective revenue flow.

Responsibilities:

• Claim Processing and Submission: Prepare, verify, and electronically submit primary, secondary, and tertiary insurance claims promptly and accurately, ensuring all necessary documentation (e.g., CPT, ICD-10 codes, physician documentation) is included for clean submission.

• Accounts Receivable (A/R) Management: Diligently monitor and manage the accounts receivable aging report, proactively identifying, researching, and resolving denied or rejected claims and unpaid balances through appeals, resubmissions, and payer follow-up.

• Payment Posting and Reconciliation: Accurately post and reconcile electronic and manual payments from insurance carriers and patients, ensuring proper allocation and balancing of accounts.

• Patient Billing and Inquiries: Manage the patient billing cycle, generate and distribute accurate patient statements, and professionally handle complex patient inquiries regarding balances, insurance coverage, and payment options with empathy and clarity.

• Verification and Authorization: Conduct pre-treatment insurance eligibility and benefit verification, and secure necessary authorizations/pre-certifications for services to minimize claim denials.

• Coding Compliance: Work closely with Medical Records and clinical staff to ensure documentation supports the billed codes, maintaining up-to-date knowledge of coding guidelines (e.g., ICD-10, CPT) and regulatory changes.

• Compliance and Audits: Ensure all billing practices adhere strictly to government regulations, payer contracts, and organizational compliance standards, participating in internal and external billing audits as required.

• System Maintenance: Utilize and maintain proficiency in the billing software and practice management system to track claims, payments, and patient accounts effectively.

Requirements:

• Education: Associate Degree in Business, Accounting, Health Information Technology, or a related field, or equivalent practical experience.

• Experience: Proven experience (3+ years) in medical billing, claims processing, and A/R management within a healthcare provider setting (clinic or hospital).

• Technical Knowledge: Comprehensive understanding of the full revenue cycle process, including claim life cycles, denial management, appeals processes, and explanation of benefits (EOB) analysis.

• Coding Proficiency: Working knowledge of medical terminology, anatomy, and standard medical coding systems (e.g., CPT, ICD-10).

• System Skills: High proficiency in using medical billing software and Electronic Health Record (EHR) systems; advanced skills in Microsoft Excel/spreadsheets.

• Integrity and Accuracy: Demonstrated commitment to handling sensitive financial and patient information with high integrity, accuracy, and confidentiality.

• Communication Skills: Exceptional written and verbal communication skills for effective interaction with insurance companies and clear, professional communication with patients.

• Problem-Solving: Strong analytical and critical thinking skills to research and resolve complex billing discrepancies and maximize reimbursement.

• Regulatory Awareness: Familiarity with the rules and regulations governing health insurance claims and patient privacy.

Your dedicated and professional management of our billing operations is paramount to our continued success, ensuring the financial stability that enables us to provide exceptional patient care.