The Insurance Billing Specialist is responsible for managing and processing insurance claims, ensuring accurate billing, timely reimbursement, and compliance with payer requirements. This role serves as a key link between patients, providers, and insurance companies to resolve billing issues and minimize claim denials.

Key Responsibilities

Submit and follow up on insurance claims (commercial, Medicare, Medicaid, etc.)
Verify patient insurance eligibility and benefits
Review coding (CPT, ICD-10, HCPCS) for accuracy and compliance
Identify, correct, and resubmit denied or rejected claims
Post insurance payments and adjustments accurately
Investigate underpayments and discrepancies
Communicate with insurance carriers to resolve claim issues
Maintain detailed billing records and documentation
Ensure compliance with HIPAA and payer regulations
Collaborate with front office, coding, and clinical staff to resolve billing errors

Required Skills & Qualifications

High school diploma or equivalent (Associate’s degree preferred)
1–3 years of insurance billing or medical billing experience
Strong knowledge of insurance plans, billing procedures, and claim forms
Familiarity with CPT, ICD-10, and HCPCS codes
Experience with EHR/PM systems (e.g., Epic, Cerner, Athena, eClinical Works)
Strong attention to detail and analytical skills
Excellent communication and problem-solving abilities

Preferred Qualifications

Certification such as CPB, CPC, or CCS
Experience in a healthcare, hospital, or medical practice setting
Knowledge of Medicare, Medicaid, and managed care guideline