Medical Billing & Denials Specialist

Medical Billing & Denials SpecialistA Medical Billing and Denials Specialist is responsible for managing the billing process, submitting claims to insurance companies, following up on unpaid or denied claims, and ensuring timely reimbursement for healthcare services. This role plays a critical part in the revenue cycle management of the healthcare organization by identifying trends in denials and taking corrective actions. Medical Billing Expertise: Proficient in billing, claims processing (Inpatient, Outpatient, Critical Access, Rural Health), denials management, and knowledge of medical terminology, physician fee schedules, DRGs, and reimbursement procedures. Claims and Appeals Processing: Submits and follows up on insurance claims; resolves denials and rejections; prepares appeal letters with proper documentation and cross-department coordination. Account Management & Collections: Retrieves and updates patient account statuses, processes remittances, manages A/R, ensures accurate charge entry, and performs financial analysis to support revenue goals. Communication & Customer Service: Answers patient and payer inquiries, verifies insurance eligibility and authorizations, documents account activity, and maintains confidentiality in compliance with HIPAA.Operational Efficiency: Utilizes EMR systems, adheres to productivity benchmarks, meets deadlines, and demonstrates strong organizational, multitasking, and communication skills. Bachelor's degree in healthcare or business administration Experience in medical billing and denials, customer service and relevant finance experience in a health care organization a plus Certification in medical billingCSEA (MH)