Billing Specialist - Urgent Care

Billing Specialist I

The Billing Specialist I is responsible for performing insurance claim processing, billing, and follow-up to ensure timely and accurate reimbursement. This position serves as the primary contact for insurance companies and other payers, researching and resolving claim issues while maintaining compliance with billing regulations and organizational policies.

Essential Functions :

• Submits and processes claims accurately and efficiently, ensuring compliance with payer requirements and company policies.
• Communicates with insurance companies, patients, and other stakeholders to resolve billing inquiries and maintain account status.
• Reviews and reconciles credit balances, reclassifies revenue, and processes adjustments per transaction coding guidelines.
• Monitors and resolves claim denials and rejections, identifying trends and implementing corrective actions.
• Reviews and corrects claim filing edits based on payer requirements and electronic health record (EHR) system alerts.
• Maintains accurate documentation of all billing actions in the practice management system.
• Gathers, updates, and communicates billing policy changes, ensuring accessibility of up-to-date reference materials.
• Collaborates with management, clinic staff, and coding teams to ensure proper billing and collection procedures.
• Assists patients and insurance representatives with billing-related questions while maintaining professionalism.
• Ensures compliance with HIPAA regulations and maintains confidentiality of patient financial and medical information.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications :

Knowledge, Skills and Abilities :

Licenses and Certifications :