Job Description
We are looking for a Medical Billing Specialist to support a healthcare organization in Rochester Hills, Michigan on a Contract basis. This role focuses on accurate claim follow-up, insurance verification, payment review, and timely resolution of billing issues across multiple payers. The ideal candidate brings hands-on medical billing experience, works well independently, and communicates effectively with both patients and insurance representatives.
Responsibilities:
• Review payer explanations of benefits to confirm correct claim reimbursement and flag recurring payment issues or denial patterns for leadership awareness.
• Verify insurance coverage and authorization details before billing activity to help reduce avoidable claim delays and rejections.
• Investigate front-end denials through payer portals and direct payer communication, update claim information as needed, and submit corrected claims promptly.
• Re-check insurance eligibility using available verification tools, redirect claims to the appropriate payer when necessary, and bill patients when coverage does not apply.
• Handle payer correspondence, account adjustments, and refund activity with a high level of accuracy and within required timelines.
• Monitor payer notices, policy revisions, and billing regulation updates to maintain compliant and current billing practices.
• Recommend workflow enhancements by identifying trends, recurring obstacles, and opportunities to improve billing efficiency.
• Provide timely, thorough responses to patient billing questions and support account resolution efforts as needed.• At least 3 years of experience in medical billing within a healthcare, hospital, or related clinical setting.
• Practical knowledge of insurance verification and authorization processes.
• Strong ability to interpret explanations of benefits and apply findings to claim follow-up and reimbursement review.
• Experience working medical claims, billing corrections, denials, collections, and payer communications.
• Familiarity with medical coding concepts and healthcare billing procedures.
• Ability to work independently, manage priorities effectively, and maintain accuracy in a fast-paced environment.
• Clear written and verbal communication skills for interacting with patients, payers, and internal stakeholders.
