The Medical Billing Specialist position is a full-time position responsible for the medical billing, coding and collection of the primary care clinic activities and supporting the Director or Receivables Management in the billing and collection of the grants and contracts. This position ensures compliant billing practices, resolves complex billing issues, and ensures maximum reimbursement while maintaining excellent patient and provider relations. The Medical Billing Specialist serves as the subject matter expert for billing and coding processes and ensures compliance with all federal, state, payer, and organizational regulations.

General Expectations:

In the performance of their respective tasks and duties, all employees are expected to conform to the following:

• Adhere to all PRC policies and Code of Conduct standards and always exhibit all PRC's Core Values.
• Perform quality work within deadlines with or without direct supervision.
• Interact professionally with other employees, customers, and vendors.
• Work independently, while understanding the necessity for communicating and coordinating work efforts with other employees and organizations, as required.

Essential Duties/Requirements:

• Responsible for the coding, billing, and collection of the primary care clinic activities
• Work collaboratively with the physician and clinic staff to develop new service offerings to our clients
• Serve as the primary care clinic's subject matter expert for billing and coding processes and provide guidance to staff and providers as needed
• Ensure accurate and timely submission of claims to primary, secondary, and tertiary payers
• Monitor denied, unpaid, and rejected claims and coordinated appeals, corrections, and resubmissions
• Review and reconcile billing reports, payment postings, and accounts receivable balances
• Generate patient statements and invoices, including prior payments and outstanding balances
• Ensure payments are accurately posted to the appropriate patient accounts and line items
• Maintain current knowledge of payer requirements, coding updates, regulatory changes and communicate updates to staff
• Monitor compliance with federal, state, payer, and organizational billing and coding regulations
• Maintain documentation resources and coding reference tools related to billing compliance and documentation standards
• Assist in developing and implementing billing policies, procedures, and workflow improvements to maximize revenue cycle efficiency
• Prepare and present detailed billing, collections, productivity, and reimbursement reports to leadership
• Collaborate with providers, clinical staff, Billing department staff, and management to resolve billing discrepancies and improve revenue cycle operations
• Ensure protection and confidentiality of patient information in compliance with HIPAA regulations
• Assist with audits and respond to billing inquiries from patients, insurance carriers, and regulatory agencies
• Provide support to the Director of Receivables Management in order to fill in as needed
• Support departmental goals and participate in process improvement initiatives

Qualifications:

Education:

Associate degree required; Bachelor's degree in Business, Healthcare Administration, or related field preferred

Experience:

Minimum of three (3) years of medical billing, coding, insurance, and collections experience within a medical practice; medical clinic billing experience required. Prior supervisory or management experience preferred.

Certifications:

Medical coding certification preferred (CPC, CCS, or equivalent)

Knowledge and Skills:

• Strong understanding of medical billing regulations, insurance requirements, and reimbursement methodologies
• Proficiency with Electronic Medical Records (EMR) systems and claims billing software
• Familiarity with CPT, ICD-10, and HCPCS coding and medical terminology
• Knowledge of HIPAA regulations and patient confidentiality requirements
• Strong analytical, mathematical, and problem-solving skills
• Excellent communication and people skills
• Ability to multitask, prioritize responsibilities, and meet deadlines in a fast-paced environment
• Ability to work independently and collaboratively within a team environment
• Strong organizational and leadership abilities

Physical Requirements:

• Prolonged periods of sitting and working on a computer
• Ability to communicate effectively in person, by phone, and electronically
• Ability to occasionally lift up to 15 pounds

Safety Equipment

Universal Precautions

Comply with Occupational Safety and Health Administration (OSHA) rules and regulations

Life Safety Equipment (fire extinguisher)

Transportation:

Must have dependable transportation

Machines, Tool, and Equipment Used:

Computer, telephone, fax, copier

Technology Requirement:

As an employee of Peace River Center, if you are not assigned a company-issued phone, you will be required to authorize the use of the Microsoft Authenticator app on your personal mobile device. This is necessary to access our payroll and communication system, Datis, and Microsoft email, as examples. This will ensure secure and efficient communication with the organization.

Supervisory Relationship(s)

Supervises: None

Work Environment:

The work environment is fast-paced and consists of exposure to physical conditions typical of a normal office environment. The populations cared for will include patients who are confused, delusional, irrational, agitated, or uncooperative. Most of the work is performed while sitting, although the work may require occasional standing or walking and/or the lifting and carrying of small objects. A small amount of travel may be required for meetings, etc., to another PRC location.

EEO Statement

One of the greatest assets of the PRC is the ethnic, cultural, and social diversity of its employees. PRC takes great pride in the diversity and values and respect of all its employees, regardless of race, color, sex, marital status, religion, national origin, ancestry, genetic information, age, disability, gender identification, or sexual orientation.