Billing Specialist
Listed on 2026-02-26
-
Healthcare
Medical Billing and Coding, Healthcare Administration -
Administrative/Clerical
Healthcare Administration
The Koʻolauloa Health Center management team and Board of Directors are always interested in bring on passionate and talented staff members. Our current job openings are listed and updated here.
Status / Time: Full-Time
Reports to: Revenue Cycle Specialist
Position Type: Permanent
FLSA Classification: Non-Exempt
Hourly Range: $20.00 to $28.00
Job Description & Overview
To implement the revenue cycle using the Billing Status Workflow process to ensure timely submission of claims, mailing of statements and subsequent payment. The Billing Specialist works closely with the front office and providers on staff to ensure accurate and timely information.
Duties:
Execute the Billing Status Workflow process as follows:
Transmit and retrieve EDI responses and process daily
Approve claims entered, fix approved failed and re-approve daily
Batch claims and/or file paper claims daily
Work filed rejected and EDI response rejections daily
Transmit batches a second time daily
Query all new/in progress claims daily
Follow up on Filed over 30 days
Follow up paper rejections and correspondence weekly.
Enter payments daily on day received. Balance cash reports daily and monthly.
Update patient insurance information in a timely manner as the information becomes
apparent.
Hard close practice management system monthly within 5 working days of month
end. Advise accounting once closed.
Document all billing/collection actions taken on an individual account in the current
practice management system.
Counsel patients in setting up payment plans to recover outstanding balances.
Request refunds to patients when there are over payments.
Generate monthly reports for uninsured contracts (DOH Primary Care, Family
Planning & any others). Review to ensure coding is accurate and appropriate to
program. Coordinate necessary follow up with Clinical and Eligibility staff as needed
and give final report to Accounting.
Provide feedback to clinic operations staff and medical providers to ensure
appropriate coding of encounters.
Adhere to State collections and credit regulations.
Adhere to applicable Federal and State laws and regulations.
Prepare, review, and submit accurate claims to insurance companies or clients.
Follow up on outstanding payments and rejections in a timely manner.
Post payments and reconcile accounts.
Maintain detailed billing records and support audits.
Stay updated on payer rules, billing codes, and compliance regulations.
Respond promptly to billing inquiries from internal and external stakeholders.
Download Explanation of Benefits/Remittance Advice from current practice
management system and insurance websites for KHC records and audit purposes.
Maintain a list of the Explanation of Benefits/Remittance Advice and reconcile to
bank statement.
Work with third party credentialing vendors to get new Facilities/Providers
credentialed or current Facilities/Providers re-credentialed. This may include calling
insurance for requirements, completing application forms and submitting requested
documents. Follow-up status calls when insurances are taking longer than usual.
Review insurance refund request including contacting insurance for clarification.
Complete internal refund request form and attach supporting documents. Post
refund in the system and mail to the insurance.
Other duties as assigned.
Qualifications:
High school diploma or equivalent (associate’s degree preferred).
Minimum of 2 years' experience in billing.
Proficiency in billing software and electronic claims submission.
Strong analytical and communication skills.
High attention to detail and organizational ability.
Willingness to learn additional roles to support department continuity.
Preferred Skills:
Current knowledge of ICD-CPT coding.
Proficient in Microsoft Office (Word, Excel).
Strong verbal and written communication skills.
Good attention to details and follow up, good time management.
Ability to work alone and with initiative.
Ability to work effectively with different types of people.
Maintains a positive and helpful attitude; remains calm during times of stress and
urgency.
Ability to maintain confidentiality and patient privacy.
Experience:
Medical billing: 2 years (preferred).
Schedule:
Monday to Friday – (hours…
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