Prebill Claims Specialist

Trinity Employment SpecialistsTulsa, OK, US

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Job Title : Prebill Claims Specialist

Employment Type : Full-Time | MondayFriday | 8 : 00 AM 5 : 00 PM

Pay Rate : $18$20 / hour (based on experience)

Position Overview

We are seeking a detail-oriented Prebill Claims Specialist to join our billing team. This role is responsible for reviewing patient accounts before claim submission, resolving billing edits, verifying data accuracy, and assisting with patient account balances. The ideal candidate will have strong problem-solving skills, knowledge of medical billing practices, and the ability to work independently in a fast-paced environment.

Key Responsibilities

Claim Review & Edits

Review patient accounts in the billing system before submission to payers.
Identify and resolve prebill edits such as missing / invalid CPT, ICD-10, NPI, demographic mismatches, and insurance corrections.

Data Verification

Verify patient demographics, insurance eligibility, and dates of service.

Ensure ordering and rendering provider information is accurate.

Maintain accurate claim notes in the billing system for audit purposes.

Follow HIPAA and confidentiality guidelines at all times.

Collaboration & Reporting

Escalate recurring claim edit trends to billing management for process improvement.

Communicate with staff regarding corrections to insurance and demographic information.

Track and report claim edit trends and resolution times to meet timely filing requirements.

Patient Accounts (A / R)

Contact patients to collect balances and explain EOB and patient responsibility.

Work return mail and update patient addresses / demographics as needed.

Complete additional A / R tasks as assigned to ensure balances are collected.

Qualifications & Skills

Prior experience in medical billing, claim edits, or revenue cycle preferred.

Knowledge of eligibility tools such as payer portals and clearinghouse systems.

Familiarity with billing systems (lab / pathology experience a plus).

Strong attention to detail and analytical skills.

Ability to meet deadlines and work independently.

Excellent communication and customer service skills.

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Compile, compute, and record billing, accounting, statistical, and other numerical data for billing purposes. Prepare billing invoices for services rendered or for delivery or shipment of goods.

Verify accuracy of billing data and revise any errors.

Resolve discrepancies in accounting records.

Prepare itemized statements, bills, or invoices and record amounts due for items purchased or services rendered.

Operate typing, adding, calculating, or billing machines.

Post stop-payment notices to prevent payment of protested checks.

Verify signatures and required information on checks.

Keep records of invoices and support documents.

Perform bookkeeping work, including posting data or keeping other records concerning costs of goods or services or the shipment of goods.

Contact customers to obtain or relay account information.

Route statements for mailing or over-the-counter delivery to customers.

Monitor equipment to ensure proper operation.

Fix minor problems, such as equipment jams, and notify repair personnel of major equipment problems.

Review documents, such as purchase orders, sales tickets, charge slips, or hospital records, to compute fees or charges due.

Track accumulated hours and dollar amounts charged to each client job to calculate client fees for professional services, such as legal or accounting services.

Weigh envelopes containing statements to determine correct postage and affix postage, using stamps or metering equipment.

Consult sources, such as rate books, manuals, or insurance company representatives, to determine specific charges or information such as rules, regulations, or government tax and tariff information.

Compare previously prepared bank statements with canceled checks and reconcile discrepancies.

Match statements with batches of canceled checks by account numbers.

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