Medical Billing Specialist

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Medical Billing Specialist

  • Specialty:

    Accounting & Finance
  • Title:

    Medical Billing Specialist
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Our Client in Boston, MA is looking for a Medical Biller with at least 2 years of physician billing experience to join their team!

The Billing Specialist is responsible for billing and claims resolution for patients, private insurance companies, Medicaid and Medicare. He/she must effectively interact with multiple disciplines including management, financial clearance staff, nursing staff, physicians, commercial insurance carriers, government agencies, and have a high-level of expertise in understanding commercial and governmental insurance carrier rules and regulations, and the ability to manage ongoing change and think creatively.


  • Corrects procedure and diagnosis coding on claims held by claim scrubber. Confirms diagnosis and procedures with nurses and physicians to ensure information is correct; adds correct modifiers as needed.
  • Verifies that procedure charges are consistent with insurance guidelines to minimize claim denial.
  • Attaches patient co-payment and any unpaid balance money received that could not be done automatically by practice management system.
  • Responsible for monitoring open encounter list to ensure all encounters received are entered.
  • Prepares and submits insurance claims.
  • Sends all insurance verification denials to financial clearance team.
  • Identifies liability and guarantors; reviews and adjusts account balances.
  • Facilitates the interpretation of Explanation of Benefits (EOBs) and follows up as needed.
  • Posts payments and adjustments not automatically processed by the practice management system; validates payments and adjustments automatically processed by practice management system.
  • Works with athenaHealth employees to resolve claim issues identified via worklists.
  • Assists in the collection of past due accounts by following up with insurance companies to learn the status of claims after initial athenaHealth follow-up. Also submits appeals on denied claims as required after initial athenaHealth follow-up.
  • Maintains current knowledge of all CPT code changes and billing requirements.
  • Attends billing meetings and training courses requested by Billing Manager.
  • Maintains HIPAA compliance.
  • Other duties as required.

Knowledge, Skills and Required Abilities:

  • Knowledge of medical procedures, CPT codes, ICD-10 coding.
  • Knowledge of insurance company operating procedures and requirements for billing.
  • Must have the ability to maintain confidentiality of patient information and office information.
  • Must have the ability to recognize, evaluate, and correct errors.
  • Must have the ability to work with other billing office employees / vendors to obtain necessary information.  
  • Must possess exceptional communication (verbal) skills.
  • Must have skills and knowledge of computer, hardware and software. Must have the capability of working well independently as well as under direct supervision.
  • Knowledge of athenaCollector is a plus.
  • Must have experience working with HCFA 1500s and Medicaid form 5.
  • Must have experience working with Medicaid, Medicare and Commercial Insurance.


  • High school diploma and 2 years of physician office billing experience are required.



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