Medical Billing - AR Executive

Job Summary
We are seeking a detail-oriented and experienced Medical Billing Specialist to manage the accurate preparation, submission, and follow-up of insurance claims. This role requires a strong understanding of medical billing codes, insurance policies, and reimbursement procedures to ensure timely and accurate payments. The ideal candidate will be proficient in billing software and electronic health records (EHR) systems, with excellent communication skills to liaise effectively with insurance companies, patients, and internal teams. This position plays a critical role in maintaining the financial health of the organization by maximizing reimbursements and minimizing billing errors.

Key Responsibilities
- Review and prepare insurance claims with precision for submission to various payers, ensuring all information is accurate and complete.
- Verify patient insurance coverage, benefits, and eligibility prior to claim submission to prevent denials or delays.
- Apply proper coding standards, including CPT, ICD-10, and HCPCS, to ensure claims are compliant and correctly documented.
- Submit claims electronically or via paper, adhering to the specific requirements of each payer.
- Post payments received from insurance companies and patients into the billing system promptly and accurately.
- Reconcile payments against billed amounts to identify and investigate any discrepancies or inconsistencies.
- Resolve payment issues, adjustments, or denials by conducting thorough research and communication with payers.
- Monitor unpaid or denied claims regularly and follow up to ensure timely resolution and payment collection.
- Contact insurance companies directly to inquire about claim status and expedite payment processes.
- Review aging reports frequently to prioritize delinquent accounts and implement appropriate collection strategies.
- Initiate and manage appeals for denied or underpaid claims, tracking progress until resolution.
- Generate patient statements and invoices for outstanding balances, maintaining clear and professional communication.
- Collaborate with patients to establish payment plans or financial arrangements when necessary.
- Provide compassionate and clear responses to patient billing inquiries and concerns.
- Maintain organized and accurate records of all billing, collection activities, and correspondence.
- Produce detailed reports on accounts receivable status, aging trends, and collection efforts for management review.
- Prepare regular updates and summaries to keep management informed of billing performance and issues.
- Ensure strict compliance with HIPAA regulations and all relevant billing guidelines to protect patient information and organizational integrity.
- Stay current with changes in billing regulations, payer policies, and industry best practices.
- Implement strategies to maximize reimbursements while minimizing compliance risks and errors.

Required Qualifications
- Comprehensive knowledge of medical terminology, billing codes (CPT, ICD-10, HCPCS), and insurance claims processes.
- Proficiency in medical billing software and electronic health record (EHR) systems.
- Strong understanding of insurance policies, reimbursement methodologies, and billing guidelines.
- Excellent analytical skills to identify, investigate, and resolve billing discrepancies efficiently.
- Effective communication skills for professional interaction with insurance providers, patients, and internal teams.
- High attention to detail with accuracy in data entry and financial calculations.

Preferred Qualifications and Benefits
(Not specified in the original description; can be added based on company standards or omitted.)

This role offers the opportunity to contribute significantly to the financial operations of a healthcare organization by ensuring accurate billing and efficient revenue cycle management. If you have a passion for precision and patient-focused service, we encourage you to apply.