Medical Billing Specialist

Job Title: Medical Billing Specialist – U.S. Healthcare

Location: East Haven, CT
Job Type: Full time

Job Summary:

The Medical Billing Specialist, at any given time, is responsible for reviewing newly-posted charges for accuracy; reconciling patient management system-specific edits and clearinghouse rejections; managing and resolving accounts receivable for healthcare providers (including rectifying denials and no-response scenarios and those claims associated with each subset); and ensuring timely and accurate reimbursement from insurance payers and patients. This role involves thorough understanding of CPT coding and CMS guidelines, extensive follow-up with insurance companies, acute knowledge of Explanation of Benefits (EOBs), denial management, and navigating various patient management and payer systems and clearinghouses.

Key Responsibilities:

• Accurately enter medical charges into billing system as well as review claims through scrubber tool(s) to ensure demographics and coding completeness, accuracy, and compliance with payer guidelines prior to claim submission.
• Ensure all charges are entered within required turnaround times (TATs).
• Identify discrepances in each set of charges, correcting/adding appropriate modifiers, places of service (POS), sequence of codes, etc. as deemed necessary in a timely manner.
• Monitor and resolve edit and rejection queues in a timely and efficient manner to meet submission deadlines.
• Track and document recurring edit and rejection trends to support training and process improvement initiatives.
• Monitor and manage accounts receivable aging reports for assigned clients.
• Conduct insurance follow-up via phone calls, emails, and payer portals to resolve unpaid or denied claims.
• Interpret EOBs and ERAs to determine appropriate action on claims.
• Reconcile Denials, No-Response scenarios, and Clearinghouse Rejections and assess any trending within each subset, prioritizing work based on aging, account-related situations (should they present), and/or payer guidelines.
• Correct and resubmit denied or rejected claims as necessary.
• Document all follow-up activities and claim-status updates in billing software.
• Communicate effectively with payers, providers, and internal teams to resolve claim issues.
• Identify trends in denials and underpayments to support root cause analysis and improvement.
• Work with patients regarding outstanding balances while maintaining flexible and empathetic mindset.
• Collaborate with internal teams (coding, charge-entry, patient services) to resolve claim issues.
• Ensure compliance with HIPAA and all relevant federal, state, and payer-specific regulations.

Required Qualifications:

• 2+ years of experience in U.S. healthcare AR, medical billing, and/or revenue cycle operations.
• Strong knowledge of commercial and government insurance (Medicare, Medicaid, etc.).
• Acute familiarity with CPT, ICD-10, and HCPCS codes.
• Experience with clearinghouses, scrubber tools, EHR/PM systems (e.g., EPIC, Athena, Kareo, AdvancedMD, eClinicalWorks), and payer portals.
• Ability to read and interpret EOBs/ERAs and payer guidelines.
• Proficient in reading and analyzing EOBs/ERAs and insurance denials.
• Strong attention to detail and accuracy.
• Excellent communication and analytical/problem-solving skills.
• Proficiency in Microsoft Excel and medical billing software.

Preferred Qualifications:

• Experience working in a medical billing company environment.
• EPIC experience
• Certified as a Medical Biller (or related certification) and/or CPC.
• Experience with medical billing for wide spectrum of specialties (e.g., cardiology, radiology, primary care, behavioral health).

Working Conditions:

• Standard business hours, with flexibility for occasional extended hours during month-end or high-volume periods.