The Billing Associate is responsible for ensuring the accurate and timely processing of billing and medical claims within the ambulatory practice setting. This role supports the revenue cycle by verifying insurance coverage, posting charges,submitting clean claims, reviewing front-end denials, and posting time-of-service payments. The Billing Associate collaborates closely with Corporate RCM, clinical teams, and administrative staff to ensure compliance with payer guidelines and corporate policies. 

Charge Entry and Claims Processing

• Review reports, encounter forms, fee tickets, and medical records to accurately capture, enter or accept charges.
• Verify patient and insurance information before claim submission.
• Ensure all necessary documentation, authorizations, and codes are complete prior to claim submission.
• Validate accuracy of CPT, ICD-10, and modifier codes before claim submission.
• Post patient payments accurately in the practice management system.
• Balance batches and reconcile payments against system reports.

Insurance Verification and Authorization

• Verify patient insurance eligibility and benefits prior to appointments or procedures.
• Obtain and document pre-authorizations and referrals required for specialist services.
• Communicate with patients and providers regarding coverage limitations and out-of-pocket costs.
• Maintain updated knowledge of payer-specific requirements and medical necessity policies for specialty procedures.
• Update patient records with accurate insurance and demographic information.

Patient Account Support

• Respond to patient billing inquiries courteously and professionally.
• Escalate billing discrepancies or issues to RCM as needed.

Billing Reports and Compliance

• Run, review, and work all daily, weekly, and monthly billing reports.
• Manage and resolve worklog tasks and claims manager edits, ensuring timely review, correction, and documentation.
• Assist with internal audits and quality control reviews of billing data.
• Participate in SOX review process and ensure unresolved items are addressed per policy.
• Ensure billing practices comply with HIPAA, CMS, and payer-specific regulations.
• Maintain confidentiality and secure handling of patient and financial data.
• Stay current with coding updates (ICD-10, CPT, HCPCS) and insurance billing guidelines relevant to the specialty.

Collaboration and Support

• Identify trends in denials or claim errors and communicate recurring issues to the Billing Manager or Practice Administrator for process improvement.
• Coordinate with front-desk staff and clinical teams to resolve billing-related issues.
• Provide feedback to providers regarding documentation requirements for accurate billing.
• Participate in departmental meetings and contribute to process improvement initiatives.
• Assist with end-of-month reporting and reconciliation as needed.

Education:

• High school diploma or equivalent required; associate’s degree or certification in medical billing and coding preferred.                                                           

Experience Industry: Healthcare

Experience:

• 2+ years of medical billing experience, preferably in a specialist or ambulatory practice setting
• Working knowledge of CPT, ICD-10, and HCPCS coding required
• Strong understanding of commercial and government payer policies and claim workflows required
• Proficiency with electronic health record (EHR) and practice management preferred

Skills/Abilities:

• Excellent attention to detail, analytical, and problem-solving skills
• Effective communication and customer service abilities