Billing Specialist (51258)

Job Title: Direct Billing Specialist

Job Summary

We are seeking an organized and precise Direct Billing Specialist to oversee our direct-invoice and clinical trial accounts. In this role, you will be responsible for creating, verifying, and distributing direct bills, keeping clear transactional records, and serving as the primary point of contact for billing and payment discrepancies. Your main objective will be to eliminate invoicing errors, submit timely claims and invoices, resolve payment delays, and ensure that our organization maintains an efficient and compliant cash inflow.

Essential Duties and Responsibilities

• Invoice Generation: Prepare, review, and issue comprehensive claims and invoices to direct bill and clinical trial payers.

• Account Verification: Audit patient accounts, contracts, or insurance policies to verify billing criteria, codes, and correct pricing metrics before sending out claims and invoices.

• Payment Processing: Receive, post, and reconcile electronic bank drafts, wire transfers, and credit card payments to the appropriate patient accounts.

• Discrepancy Resolution: Promptly investigate denied claims, underpayments, or billing disputes by collaborating with internal operational teams and payers.

• Accounts Receivable Monitoring: Identify delinquent balances and initiate professional, courteous outreach (via phone, email, or mail) to establish structured payment timelines.

• System Maintenance: Maintain data integrity by routinely updating client contact information within the billing database and RIS system.

Key Skills and Qualifications

• Numerical & Analytical Skills: High aptitude for basic math and identifying patterns or errors within billing records.

• Communication & Negotiation: Exceptional written and verbal communication skills needed to handle sensitive financial issues with empathy, authority, and professionalism.

• Software Proficiency: High proficiency with Microsoft Office products (specifically Excel and functions such as basic formulas, data filtering, VLOOKUPs, pivot tables) and experience navigating Electronic Health Record (EHR) or billing systems.

• Industry Compliance: Familiarity with data security rules, regulatory frameworks, and specialized protocols (such as HIPAA).

• Medical Knowledge: Working knowledge of medical terminology, CPT’s, and ICD-10 coding.

Education and Experience Requirements

• Education: High school diploma or equivalent is required; an Associate’s or Bachelor’s degree in Healthcare Administration, Accounting, or related field is preferred.

• Experience: Minimum of 2 to 3 years of direct experience working in a medical office environment handling billing, claims processing, or accounts receivable.