Cycle Revenue Ob​/Gyn Billing Specialist

Job Summary

Job Summary Sovereign Women's Healthcare is seeking an experienced and detail-oriented Full Cycle Billing Specialist to manage the complete revenue cycle for our OB/GYN practice. This role is essential to maintaining the financial health of the practice while ensuring accurate, ethical, and timely billing for women's health services. The candidate should have a strong knowledge of the medical billing processes, payer guidelines, and OB/GYN coding nuances.

The candidate should be comfortable working independently while communicating clearly with providers and staff.

Responsibilities include (but not limited to):

• Review and verify medical documentation to ensure accuracy of diagnoses and procedures using ICD-9, ICD-10, CPT codes, and DRG classifications.
• Accurate charge entry and claim submission for OB/GYN services, procedures, and surgeries.
• Assign appropriate medical codes based on detailed review of patient records, including medical terminology and records management.
• Prepare and submit claims electronically through EMR (Electronic Medical Records) and EHR (Electronic Health Records) systems, ensuring compliance with payer requirements.
• Reviewing encounters for completeness and correcting missing and inconsistent information .
• Verifying coding accuracy and identifying potential billing issues before submission
• Posting insurance and patient payments accurately .
• Follow up on unpaid or denied claims promptly through medical collection efforts, appealing when necessary to maximize reimbursement.
• Collaborate with provider and staff to clarify documentation discrepancies and improve coding accuracy for future billing cycles.
• Maintain detailed records of billing activities, claims status, and collections in accordance with healthcare regulations.
• Stay current on updates in medical coding standards, including ICD-9, ICD-10, CPT coding changes, and regulations affecting obstetrics and gynecology billing.
• Submitting appeals, reconsiderations, and corrected claims as needed.
• Monitoring accounts receivable and working aging report reduce the outstanding balance .
• Communicating with insurance carriers regarding claim status and reimbursement issues.
• Sending statements to the patients
• Identifying trends in denials or underpayments and reporting findings to management.
• Assisting with patient billing inquiries related to insurance claims and balances.
• Maintaining compliance with payer guidelines, HIPPA, and billing regulations
• Working with the EMR/practice management system (Greenway preferred)
• Collaboration with front desk and clinical staff to resolve documentation or demographic issues affecting billing

• Proven experience in full cycle medical billing within an Ob/Gyn practice for at least 2 years
• Strong knowledge of DRG classifications, CPT coding, ICD-9/ICD-10 coding systems, and medical terminology within an Ob/Gyn practice.
• Familiarity with EMR/EHR systems used for documentation and billing processes.
• Excellent understanding of medical records management and the importance of accurate documentation for billing purposes.
• Experience with claim follow-up, denials management, and appeals.
• Familiarity with commercial insurance , Medicaid, and Medicare payers.
• Demonstrated ability to perform medical collection activities effectively while maintaining professionalism.
• Experience working with insurance payers to resolve claim issues swiftly and efficiently.
• Exceptional attention to detail, organizational skills, and the ability to multitask in a fast-paced environment.
• Knowledge of payer
  -specific policies and authorization requirements .
• Excellent attention to detail and organization skills.
• Strong communication skills and ability to work independently.
• EMR/practice management system experience required (Greenway preferred)

Job Type: Contract

Work Location:

Hybrid remote in Roswell, GA 30076