Virtual Medical Billing Specialist - Claim Creation & Follow-Up

As a Billing Specialist at Enticare, you will be instrumental in ensuring the smooth processing of medical claims from start to finish. This includes the accurate creation of claims and diligent follow-up on denied claims to ensure appeals are filed and reimbursements are secured. Your role requires a strong understanding of CPT codes, modifiers, place of service, patient eligibility, and insurance policies. We seek a detail-oriented professional who is knowledgeable about billing regulations and passionate about maintaining the highest standards in healthcare billing practices.

Key Responsibilities:
Accurately create and submit medical claims using appropriate CPT codes, modifiers, and place of service information.
Verify patient eligibility and insurance coverage to ensure proper claim processing.
Follow up on denied claims promptly, ensuring all necessary appeals are filed and pursued to resolution.
Collaborate with healthcare providers, coding specialists, and other stakeholders to gather accurate and complete information for claim creation and follow-up.
Stay informed about changes in billing regulations, coding guidelines, and insurance policies.
Address claim-related issues, including rejections, and ensure corrections and resubmissions are completed in a timely manner.
Maintain detailed records of claim activities, including appeals and outcomes.
Work closely with the billing team to ensure claim completeness and accuracy.
Qualifications:
Proven experience as a Billing Specialist with a focus on claim creation and follow-up in a healthcare setting.
Demonstrated expertise in handling denied claims and navigating the appeals process.
In-depth knowledge of CPT codes, modifiers, and place of service requirements.
Familiarity with insurance verification processes and eligibility criteria.
Proficiency in billing software and electronic health record (EHR) systems.
Strong analytical and problem-solving skills.
Excellent communication and interpersonal abilities.
Ability to work collaboratively in a team-oriented environment.

Experience:
Proven experience in payment posting and claim management within a medical clinic or healthcare environment.