Billing Specialist
Core
Manage medical billing and reimbursement processes, ensuring accurate claims submission, accounts receivable monitoring, and timely payment resolution for Minnesota Medical Assistance and commercial payers.
Role type
Billing Specialist (Healthcare Revenue Cycle)
Builds
Accurate claims, resolved payment issues, and compliant billing records for Minnesota Medical Assistance and commercial insurers
Domain
Healthcare / Medical Billing
Required skills
Medical billing, Claims submission, Accounts receivable management, Denial resolution, Appeals management, Payer communication, Insurance eligibility verification, HIPAA compliance, Microsoft 365, Excel
Preferred skills
Minnesota DHS experience, CentralReach, Certified Professional Biller (CPB), Autism/Behavioral health billing, Commercial insurance billing, Postsecondary healthcare education
Technologies
CMS-1500, Electronic claims submission, Payer portals, Electronic remittance information, MN–ITS, EIDBI, CentralReach, Microsoft 365, Excel
Responsibilities
Prepare, review, and submit accurate claims to Minnesota Medical Assistance, managed care organizations, and commercial insurance providers; Monitor assigned accounts receivable and claim statuses, investigate unpaid or underpaid claims, and follow up with payers; Analyze claim rejections and denials, correct billing errors, prepare appeals with supporting documentation, and track deadlines; Escalate unresolved or high-risk claims to the appropriate teams and stakeholders; Verify insurance eligibility and coverage, coordinating the resolution of authorization, provider enrollment, and other payer-related requirements; Maintain accurate client billing profiles, charges, payment postings, and adjustments in accordance with established procedures and approval limits; Respond to payer correspondence and documentation requests, ensuring all required records are submitted accurately and on time; Document claim follow-ups, payer communications, resolution efforts, and next steps in designated systems to maintain clear workflow visibility; Identify recurring billing issues, communicate findings to leadership, and contribute to approved process improvements; Collaborate with Revenue Cycle, Credentialing, Authorizations, and clinical teams to resolve reimbursement barriers; Support cross-training, backup coverage, and other billing activities while meeting established productivity and accuracy standards; Maintain the confidentiality of client information and ensure compliance with HIPAA and organizational policies.
Seniority
Mid-level, experienced IC