Medical Billing Specialist

Medical Billing Specialist – American Health Partners Job Summary

The Medical Billing Specialist for Nurse Practitioners is responsible for processing and mailing/transmitting claims, tracking claims, monitoring authorization and eligibility of payor benefits, managing the collections process, and posting cash receipts.

• Extract and verify billing information from medical records
• Ensure collection of past‑due balances; follow up as needed
• Maintain accurate patient demographic and insurance information before submitting claims
• Answer patient account inquiries and assist in establishing alternative payment plans as necessary
• Maintain patient account records; settle third‑party payer issues as required
• Receive and review daily reconciliation review (DAR) document for accuracy; enter charges into the Practice Management System (PMS)
• Prepare and review patient statements prior to release through PMS
• Ensure timely filing of all Medicare, Medicaid, and third‑party insurance claims
• Balance daily charges; reconcile with reports within PMS
• Collaborate with the revenue cycle manager and payers on denials/rejections
• Work closely with practice representatives to ensure proper insurance verifications and authorizations are obtained
• Perform other duties as assigned

• Comply with applicable legal requirements, standards, policies, and procedures including the Corporate Compliance Program, Corporate Code of Conduct, HIPAA, and the Federal False Claims Act
• Report concerns and suspected incidences of non‑compliance immediately to the Chief Compliance Officer
• Communicate professionally with patients and guarantors regarding balances or account information
• Participate in required orientation and training programs
• Cooperate with monitoring and audit functions and investigations
• Participate in process improvement responsibilities
• Meet productivity goals
• Successfully complete required training
• Handle multiple priorities effectively

• Problem‑solving skills to manage a variety of concrete variables
• Effective verbal and written communication skills
• Ability to interpret instruction presented in a variety of situations
• Strong organizational skills; ability to manage multiple projects simultaneously
• Proficiency with Microsoft Word, Excel, PowerPoint, and Internet Explorer
• Ten key speed and accuracy

This Organization is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or other characteristic(s) protected by federal, state, and local laws. This Organization will make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. A key part of this policy is to provide equal employment opportunity regarding all terms and conditions of employment and in all aspects of a person's relationship with the Organization, including recruitment, hiring, promotions, and termination.