Billing Specialist III presso undefined

Summary:
The Billing Specialist III is responsible for advanced-level medical billing functions, ensuring accurate claim submission, payment posting, and resolution of complex billing issues. This role often includes mentoring junior staff, managing payer escalations, and contributing to process improvement initiatives.

Key Responsibilities:

1. Claims Management

• Prepare, review, and submit electronic and paper claims for all payers (Medicare, Medicaid, Commercial, Managed Care).
• Verify coding accuracy (CPT, HCPCS, ICD-10) and correct claim errors before submission.
• Review claim rejections, denials, and edits; research and resolve issues to ensure timely payment.
• Follow up on unpaid or underpaid claims, coordinating with payers for resolution.

2. Payment Posting & Reconciliation

• Post insurance and patient payments accurately, including adjustments, denials, and refunds.
• Reconcile daily deposits, remittance advices (ERA/EOB), and accounts receivable reports.
• Identify trends in payment discrepancies or underpayments and escalate for correction.

3. Denial Management & Appeals

• Analyze claim denials, prepare appeal letters, and submit corrected claims as needed.
• Track and report recurring denial reasons to assist in process improvement and staff training.
• Collaborate with clinical and coding teams to ensure documentation supports billed services.

4. Compliance & Quality Assurance

• Ensure billing practices comply with payer policies, CMS regulations, and internal compliance guidelines.
• Maintain current knowledge of billing regulations, payer rules, and updates.
• Participate in audits and implement corrective actions as needed.

5. Team Support & Leadership

• Serve as a resource for Billing Specialist I & II staff; assist with training and complex claim resolution.
• Provide input on workflow optimization and system enhancements.
• Communicate effectively with internal departments (front desk, providers, coding, finance) to resolve billing-related issues.

6. Reporting & Analysis

• Generate and analyze A/R aging reports, denial reports, and productivity metrics.
• Support month-end close processes by ensuring all billing and payment activities are up to date.

Other Skills and Abilities:

• Attention to detail and ability to work in a fast-paced environment.
• Preferred experience/knowledge of FQHC billing guidelines and procedures.
• Solid understanding of billing software and electronic medical records.
• Maintain an up-to-date knowledge of insurance guidelines, Medicare, and state Medicaid.
• Experience with and understanding of CPT, ICD-10 coding.
• Must have the ability to multitask and manage time effectively.
• Excellent written and verbal communication skills.
• Outstanding problem-solving and organizational abilities.
• Excellent computer skills and interpersonal skills.
• Experience with eCW, a plus.
• Knowledge of healthcare governing agency policies and procedures. 
• Knowledge of medical terminology.
• Must have good interpersonal/human relations skills. 
• Ability to work independently and as part of a team
• Ability to work in a fast-paced environment

MINIMUM QUALIFICATIONS:

Minimum High School diploma, an AA or BS degree preferred or commensurate experience.

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or equivalent recognized coding certification required.
• Two (2) years of medical billing and coding experience, preferred.
• Computer skills in Microsoft Office, excellent organizational, verbal, and written communication skills.

Why work at CCI? 

• Extensive benefits plan including PTO
• 403B Retirement Plan + Employer match up to 4%
• Tuition reimbursement opportunities
• Continuing education assistance; can be used toward obtaining certifications, renewal of certifications, or possible conference attendance. 
• Our providers are insured for malpractice under FTCA.

Equal Employment Opportunity (EEO)

CCI Health Services does not unlawfully discriminatebased on race, religion, color, national origin, citizenship, ancestry,physical or mental disability, legally protected medical condition (cancerrelated or genetic characteristics or any genetic information), marital status,sex, sexual orientation, gender identity, gender expression, pregnancy, age (40or older), military and/or veteran status or any other basis protected byfederal or state law. All personnel decisions are to be administered in accordancewith this policy and in compliance with applicable federal and state law,including, but not limited to, decisions regarding recruitment, selection,training, promotion, compensation, benefits, transfers, lay-offs, tuitionassistance, and social and recreational programs.

The CEO & President of CCI and all managerialpersonnel are committed to this policy and its enforcement. Employees aredirected to bring any violation of this policy to the immediate attention oftheir supervisor, Human Resources, or the CEO & President. Any employee whoviolates this policy or knowingly retaliates against an employee reporting orcomplaining of a violation of this policy, shall be subject to immediatecorrective action, up to and including termination of employment. Complaintsbrought under this policy will be promptly investigated and handled with dueregard for the privacy and respect of all involved.

Working Conditions:

• Prolonged periods of standing, bending or working at a desk on a computer.

The ability to lift (up to 15lbs) is required.