AR & Billing Specialist
Dexian, Plano, TX, United States
We are assisting a client in the greater Dallas area that is looking to bring on an experienced accounts receivable professional to their team. They will allow for some flexibility with 1 remote day.
Billing Specialist
The Billing Specialist is responsible for ensuring claims for patient services are
accurately coded, submitted, adjudicated, and reimbursed
in a timely manner for an assigned payer panel. This role requires
hands‑on medical billing experience across the full revenue cycle , including claim submission, EOB review, payment posting, and denial resolution. The Billing Specialist will collect and enter claim and payment data,
analyze payer explanations of benefits (EOBs/ERAs) , and collaborate with internal teams to maximize reimbursement accuracy, efficiency, and prompt claim resolution throughout the claim life cycle.
Essential Duties and Responsibilities
Responsible for managing primary, secondary, and tertiary claims from submission through final payment or resolution.
Submits clean and compliant claims via electronic clearinghouse or paper forms in accordance with payer guidelines.
Reviews claim acknowledgements, acceptance reports, and rejections to ensure timely correction and resubmission.
Conducts follow‑up with insurance companies regarding unpaid, denied, or underpaid claims.
Interprets EOBs to identify payment discrepancies, contractual adjustments, bundling issues, and patient responsibility.
Documents denial reasons and trends; provides feedback to improve billing workflows, coding accuracy, and documentation practices.
Prepares and submits appeals with supporting documentation, medical records, and corrected claims as required.
Ensures electronic and manual insurance and patient payments are accurately posted and reconciled in the medical billing system.
Identifies underpayments and initiates payer reconsiderations or appeals as appropriate.
Ensures claims are complete, accurate, and payer‑compliant prior to submission.
Resolves duplicate claim and ticketing issues.
Reviews clinical documentation to confirm appropriate
ICD‑10, CPT, and HCPCS coding .
Ensures accurate modifier usage and compliance with payer and CMS rules.
Verifies patient demographics, insurance eligibility, coordination of benefits (COB), and prior authorizations.
Corrects minor coding or data errors and escalates complex issues as needed.
Initiates and tracks communication with providers, coders, and front‑end staff until claim issues are resolved.
Clearly communicates insurance outcomes and patient financial responsibility.
Responds to patient inquiries regarding charges, insurance payments, EOBs, and outstanding balances.
Explains patient responsibility amounts based on EOBs, including deductibles, copays, coinsurance, and non‑covered services.
Assists with processing patient statements for balances not covered by insurance.
Assists with follow‑up on past‑due balances and coordination with collection agencies when necessary.
Workflow Analysis and Reporting
Monitors billing performance, accuracy, and compliance.
Maintains systems to track and report claim errors, denials, and resolution outcomes by individual and site.
Analyzes denial and EOB data to identify payer trends, root causes, and revenue impact.
Maintains reporting for point‑of‑service collections and daily deposits.
Ensures compliance with organizational policies, payer contracts, and regulatory requirements.
Education and Experience
High School Diploma or GED required.
Two or more years of experience in medical billing, claims follow‑up, and EOB analysis , preferably within a healthcare or clinical setting.
Demonstrated knowledge of
insurance claim adjudication, EOB interpretation, denial management, and appeals processes .
Working knowledge of CPT, ICD‑10, modifiers, and payer billing requirements.
Efficient keyboarding and data‑entry skills.
Preferred Skills
Knowledge of medical billing.
Experience with ERAs, EOB reconciliation, payer portals, and Medicaid/Medicare guidelines.
Familiarity with billing software and electronic clearinghouses.
#J-18808-Ljbffr
Billing Specialist
The Billing Specialist is responsible for ensuring claims for patient services are
accurately coded, submitted, adjudicated, and reimbursed
in a timely manner for an assigned payer panel. This role requires
hands‑on medical billing experience across the full revenue cycle , including claim submission, EOB review, payment posting, and denial resolution. The Billing Specialist will collect and enter claim and payment data,
analyze payer explanations of benefits (EOBs/ERAs) , and collaborate with internal teams to maximize reimbursement accuracy, efficiency, and prompt claim resolution throughout the claim life cycle.
Essential Duties and Responsibilities
Responsible for managing primary, secondary, and tertiary claims from submission through final payment or resolution.
Submits clean and compliant claims via electronic clearinghouse or paper forms in accordance with payer guidelines.
Reviews claim acknowledgements, acceptance reports, and rejections to ensure timely correction and resubmission.
Conducts follow‑up with insurance companies regarding unpaid, denied, or underpaid claims.
Interprets EOBs to identify payment discrepancies, contractual adjustments, bundling issues, and patient responsibility.
Documents denial reasons and trends; provides feedback to improve billing workflows, coding accuracy, and documentation practices.
Prepares and submits appeals with supporting documentation, medical records, and corrected claims as required.
Ensures electronic and manual insurance and patient payments are accurately posted and reconciled in the medical billing system.
Identifies underpayments and initiates payer reconsiderations or appeals as appropriate.
Ensures claims are complete, accurate, and payer‑compliant prior to submission.
Resolves duplicate claim and ticketing issues.
Reviews clinical documentation to confirm appropriate
ICD‑10, CPT, and HCPCS coding .
Ensures accurate modifier usage and compliance with payer and CMS rules.
Verifies patient demographics, insurance eligibility, coordination of benefits (COB), and prior authorizations.
Corrects minor coding or data errors and escalates complex issues as needed.
Initiates and tracks communication with providers, coders, and front‑end staff until claim issues are resolved.
Clearly communicates insurance outcomes and patient financial responsibility.
Responds to patient inquiries regarding charges, insurance payments, EOBs, and outstanding balances.
Explains patient responsibility amounts based on EOBs, including deductibles, copays, coinsurance, and non‑covered services.
Assists with processing patient statements for balances not covered by insurance.
Assists with follow‑up on past‑due balances and coordination with collection agencies when necessary.
Workflow Analysis and Reporting
Monitors billing performance, accuracy, and compliance.
Maintains systems to track and report claim errors, denials, and resolution outcomes by individual and site.
Analyzes denial and EOB data to identify payer trends, root causes, and revenue impact.
Maintains reporting for point‑of‑service collections and daily deposits.
Ensures compliance with organizational policies, payer contracts, and regulatory requirements.
Education and Experience
High School Diploma or GED required.
Two or more years of experience in medical billing, claims follow‑up, and EOB analysis , preferably within a healthcare or clinical setting.
Demonstrated knowledge of
insurance claim adjudication, EOB interpretation, denial management, and appeals processes .
Working knowledge of CPT, ICD‑10, modifiers, and payer billing requirements.
Efficient keyboarding and data‑entry skills.
Preferred Skills
Knowledge of medical billing.
Experience with ERAs, EOB reconciliation, payer portals, and Medicaid/Medicare guidelines.
Familiarity with billing software and electronic clearinghouses.
#J-18808-Ljbffr