The Medical Billing Specialist is responsible for preparing, submitting, tracking, and following up on medical claims for healthcare providers across the United States. The role ensures accurate reimbursement by complying with federal regulations, payer guidelines, and HIPAA standards while minimizing claim denials and improving revenue collection.
Key ResponsibilitiesInsurance Verification
- Verify patient demographics and insurance eligibility.
- Confirm coverage, deductibles, copayments, and coinsurance.
- Obtain prior authorizations when required.
Charge Entry
- Review provider documentation.
- Enter patient charges accurately into the Practice Management (PM) system.
- Validate diagnosis and procedure codes before claim submission.
Claim Submission
- Prepare and submit electronic claims (EDI) to commercial and government payers.
- Review claims for completeness and accuracy.
- Ensure timely filing according to payer guidelines.
Accounts Receivable (AR) Follow-Up
- Monitor unpaid claims.
- Contact insurance companies regarding claim status.
- Resolve claim rejections and denials.
- File corrected claims and appeals.
Payment Posting
- Post Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB).
- Reconcile insurance and patient payments.
- Identify underpayments and overpayments.
Denial Management
- Investigate denied claims.
- Prepare appeal documentation.
- Track appeal outcomes.
- Reduce recurring denial trends.
Patient Billing
- Generate patient statements.
- Explain balances and payment options.
- Process patient payments.
- Coordinate payment plans when applicable.
Compliance
- Maintain HIPAA compliance.
- Follow CMS regulations.
- Adhere to payer-specific billing policies.
- Protect patient confidentiality.
Reporting
- Prepare daily productivity reports.
- Monitor AR aging.
- Analyze reimbursement trends.
- Report billing issues to management.
- 1–3 years of US Medical Billing experience
- Experience with physician or hospital billing
- Experience in Revenue Cycle Management
Pay: ₹25,000.00 - ₹100,000.00 per month
Work Location: In person
