Job Summary

The Medial Billing Specialist is responsible for managing all aspects of the medical billing

and collections process for a multi-location urgent care organization. This role ensures the

timely and accurate submission of claims, effective management of accounts receivables, and

resolutions of billing issues including: denials, rejections, and modifier/coding issues to

maximize reimbursement and maintain compliance with payer regulations.

The Medical Billing Specialist, under the direction of the RCM manager will collaborate

closely with providers, front office staff, clinical teams, and management to identify and

resolve claim issues, improve charge capture, and ensure the efficient flow of revenue

throughout the billing cycle.

Essential Duties and Responsibilities

Claims Management

• Review, prepare, and submit electronic and paper claims accurately and timely.

Typically, within 24 hours of patient discharge.

• Verify Claim completeness, coding accuracy, and supporting documentation prior to

claim submission.

• Monitor Claim acceptance, rejections, and edits through the clearinghouse and

payer systems.

• Correct and resubmit rejected or denied claims promptly through our PM or

clearinghouse system.

Accounts Receivable Management

• Proactively manage and work assigned accounts receivable to ensure timely

reimbursement and achievement of organizational A/R goals.

• Analyze aging reports and prioritize accounts based on payer, balance, aging

category, and reimbursement impact.

• Follow up on outstanding claims through payer portals, telephone inquiries, and

written correspondence to secure payment and resolve claim delays.

• Identify, investigate, and resolve underpayments, payment variances, denials, and

non-payment issues in a timely manner.

• Monitor accounts approaching timely filing limits and take appropriate action to

prevent avoidable write-offs.

• Maintain designated A/R work queues and productivity standards established by the

organization.

• Escalate complex payer disputes, contract discrepancies, and unresolved

reimbursement issues to management as appropriate.

• Identify trends contributing to increased A/R, denial rates, or delayed payments and

recommend corrective actions.

• Collaborate with front office, back office, coding, and provider teams to address

root causes of billing issues affecting reimbursement.

• Assist in developing workflows and process improvements designed to reduce days

in A/R and increase collection efficiency.

• Pursue all appropriate reimbursement opportunities while ensuring compliance with

payer contracts, regulations, and organizational policies.

• Monitor outstanding patient balances and coordinate with applicable departments to

facilitate resolution when necessary.

• Maintain accurate documentation of all collection activities, payer communications,

appeals, and account actions within the practice management system.

• Support month-end and year-end revenue cycle initiatives by focusing on aged

receivables and high-priority collection opportunities.

• Consistently work to reduce aged accounts and maintain overall accounts receivable

performance within established organizational benchmarks and goals.

Denials and Appeals

• Analyze denial reasons and prepare appeals with supporting documentation.

• Track appeal outcomes and identify opportunities to reduce recurring denials.

• Escalate complex payer issues to billing leadership as appropriate.

Revenue Cycle Collaboration

• Partner with front office teams to resolve registration, eligibility, authorization, and

demographic issues.

• Work with back office staff and providers to clarify documentation and coding

concerns.

• Participate in process improvement initiatives to enhance revenue cycle

performance.

Payment Posting and Reconciliation

• Assist with payment review and reconciliation as needed.

• Identify payment discrepancies and coordinate corrections.

• Ensure adjustments, write-offs, and refunds are processed according to

organizational policies.

Compliance and Documentation

• Maintain compliance with HIPAA, federal and state regulations, and payer

guidelines.

• Stay current with CPT, HCPCS, ICD-10, and payer billing requirements.

• Accurately document account activities within the practice management system.

Communication and Working Habits

• Ability to meet deadlines and prioritize workload and tasks on an ongoing basis

• Exceptional customer service skills and positive personality attributes

• Excellent communication and listening skills – clear, concise, articulate, empathetic

and friendly.

• Works well with all staff members including management, administration, and

clinical staff.

• Exceptional interpersonal communication skills with a positive tone and welcoming

body language.

• Ability to work independently on assigned tasks as well as to accept directions

on given assignments.

Qualifications

Required

• High school diploma or equivalent.

• Minimum of 2 years of medical billing experience.

• Knowledge of medical terminology, insurance plans, CPT, HCPCS, and ICD-10

coding principles.

• Experience working with commercial, Medicare, Medicaid/Medi-Cal, Workers'

Compensation, and managed care payers.

• Proficiency with electronic health records (EHR), practice management software,

and clearinghouse systems.

• Strong analytical, organizational, and problem-solving skills.

• Excellent verbal and written communication skills.

• Ability to manage multiple priorities in a fast-paced environment.

Preferred

• Experience in urgent care, emergency medicine, family practice, or multi-specialty

medical billing.

• Certified Professional Biller (CPB) certification or equivalent.

• Experience managing high-volume accounts receivable and denial resolution.

• Knowledge of multi-location healthcare operations.

Core Competencies

• Claims Processing and Follow-Up

• Denial Management

• Accounts Receivable Resolution

• Attention to Detail

• Time Management

• Interdepartmental Collaboration

• Customer Service

• Regulatory Compliance

• Critical Thinking

Physical Requirements

• Ability to sit for extended periods while working on a computer.

• Ability to communicate effectively via phone, email, and video conferencing.

• Must be able to life 25 lbs.

Performance Expectations

• Maintain timely claim submission and follow-up activities.

• Meet established productivity and quality standards.

• Consistently work assigned AR to reduce aging balances and maximize reimbursement.

• Reduce balances aged greater than 90 days.

• Minimize avoidable write-offs related to timely filing or insufficient follow-up.

• Foster positive working relationships with clinic staff, providers, and payer

representatives.

• Support organizational goals for revenue cycle efficiency, compliance, and patient

satisfaction.

• Responsible for showing up to work on time and clocks in/out as defined by

AUC Policies