Medical Biller & Transaction Posting Specialist - St. Petersburg, FL

Job Description: Medical Biller & Transaction Posting Specialist – St. Petersburg, FLHybrid Position – four (4) days a week from home and one (1) day a week in office. Join our team at Florida Pediatric Associates and be a part of an exciting, dynamic workplace where your contributions matter. We’re looking for a motivated, detail-oriented individual who thrives in a collaborative environment and wants to grow with us.

Skills Working knowledge of: Electronic Remittance Advices (ERA) payments. Experience in processing refunds. Medicare and Florida Medicaid coding rules and regulations, including but not limited to National Correct Coding Initiative edits and payer guidelines. Current International Classification of Diseases (ICD), Current Procedural Technology (CPT), and Healthcare Common Procedure Coding System (HCPCS) coding and terminology. Microsoft Office software applications, including Outlook, Word, and Excel. Database software and data entry. Operation of office equipment, including Fax machines, copiers, scanning devices, and management of scanned documents. Understanding of: Knowledge of medical terminology, insurance explanation of benefits (EOBs), and electronic remittance advice (ERA).Familiarity with Current Procedural Terminology (CPT), Internal Classification of diseases 10th Revision (ICD-10), and Healthcare Common Procedure Coding System (HCPCS) codes preferred. Medical billing processes, including charge entry, claim submission, payment posting. Insurance verification processes, eligibility checks, and prior authorization requirements. Principal Duties and Responsibilities Medical Billing: Receive and log daily charge lag, for charges submitted by practices and notify management of any delays or issues that may impact departmental policies, procedures, or turnaround times. Review manual charges for completeness, accuracy and inconsistencies prior to posting. Post or process electronic charges to the Practice Management (PM) system per policy and procedure. Utilize the PM system claims scrubber to ensure accurate ICD10 and CPT coding compatibility, site of service billing compliance and to comply with payer billing and reimbursement policies. Reconcile practice charges against appointment schedules, rounding lists, charge capture systems, and other applicable sources to confirm all patient charges are captured accurately. Verify patient insurance eligibility as needed to support accurate claim submission. Review patient accounts for accuracy, including charges, payments, adjustments, and demographic information. Access facility systems and patient health records to obtain or confirm current demographic and insurance information when necessary. Communicate with practice staff regarding missing, incomplete, or incorrect encounter documentation and billing information. Review and resolve front-end claim rejections related to demographic, coding, or charge posting errors. Post manual and electronic charges into the practice management billing system while meeting established productivity and quality standards. Apply appropriate billing modifiers in accordance with coding and payer guidelines. Review and resolve claim edits, including National Council on Compensation Insurance (NCCI) and coding-related edits, as appropriate. Utilize physician charge capture applications and related billing systems as required. Transaction Posting: Accurately post insurance payments, ERA’s, contractual adjustments, credits and denials to patient accounts in a timely fashion to meet or exceed performance standards defined in Department Policies and Procedures. Reconcile ERA’s, insurance payments, to the daily bank report. End of Day Report, merchant transaction report and daily deposits to the daily payment summary report in the Practice Management System. Scan payer EOB and patient checks into the Practice Management System according to department policies and procedures. Scan End of Day Reports and all supporting documentation into the designated folder on the document server. Review patient credit balance report and credit transfers and confirm that refunds are accurate. Process patient credit card payments when necessary. Post patient and insurance company refund checks to the Practice Management System. Post unidentified payments to the correct suspense account and document all transactions to create a verifiable record that meets audit standards. Resolve misdirected payments and return incorrect payments to the sender. Maintain payment records, reports and files according to department policies and procedures. Prepare, and scan remote capture (deposit) and record the daily bank deposits per department policies and procedures. Process, post and mail refund checks. Promptly report matters that delay or disrupt workflow to the department director or designee.