Description
POSITION SUMMARY
The Billing Specialist is responsible for all aspects of billing inpatient and outpatient claims. The Billing Specialist, a key position in the Revenue Cycle, facilitates the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries and patients. The incumbent will assist in the clarification and development of process improvements and inquiries in order to maximize revenues.
Work is typically performed in an office environment, but this position has the option to work from home but may also be needed onsite for projects or team meetings from time to time. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements for this job description are not intended to be all inclusive. They represent typical elements considered necessary to successfully perform the job.
Requirements
ESSENTIAL JOB DUTIES and FUNCTIONS
While living and demonstrating our Core Values, the Billing Specialist will:
- Perform and monitor all steps in the billing processes to ensure maximum reimbursement from patients, government and commercial payers as well as from special billing arrangements
- Prepare and submit clean claims to third party payers either electronically or by paper
- Follow billing guidelines and legal requirements to ensure compliance with federal and state regulations
- Respond to account inquiries from patients, payers, providers, and/or other staff as requested
- Identify and resolve patient/insurance billing issues
- Work closely with team members regarding claim appeals, denials, resolution, and education
- Understand Medicare, Medicaid and other commercial payer rules and regulations applicable to billing. Update providers, learners, office staff, clinics, and faculty of changes as appropriate
- Responsible for contributing to the areas for coding, billing, and documentation education that is being reviewed for all providers and residents, related to billing coding and errors.
- Responsible for contributing to new learner education related to billing and collections
- Understand the considerations of coding in Value Based payment contracts
- Responsible for reviewing and implementing changes from payer bulletins
- Use online healthcare databases and other resources for verification and claim status
- Deliver the highest quality service to internal and external customers
- Assist other members of the team with projects as needed
- Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations
PREFERRED QUALIFICATIONS
- Certified Biller
- FQHC Billing
Skills Required
- Experience billing inpatient and outpatient claims
- Prepare and submit clean claims electronically and by paper
- Knowledge of Medicare, Medicaid, and commercial payer rules and regulations
- Familiarity with billing guidelines, federal and state regulations, and HIPAA compliance
- Experience identifying and resolving claim denials, appeals, and payer inquiries
- Use online healthcare databases and resources for verification and claim status
- Contribute to coding, billing, and documentation education for providers and learners
- Certified Biller
- FQHC Billing experience
What We Do
The Wright Center Medical Group (The Wright Center/Wright Center for Community Health) is a nonprofit community health organization operating teaching health centers and patient‑centered medical homes across northeastern Pennsylvania. It provides comprehensive primary care, behavioral health, addiction medicine, dental and specialty services, coordinates community supports, and trains residents and fellows—focusing on whole‑person care, access for underserved populations, and improving community health outcomes.
