Medical Claims Specialist

Located in Tyler, TX

Salary: up to $17.00/hr

 

Job Title: Medical Billing Specialist

---

Overview:
We are looking for a detail-oriented and experienced Medical Billing Specialist. This role goes beyond routine billing — we need someone who can dig into complex claim issues, identify patterns, and take the right steps to get claims resolved and reimbursements collected. The ideal candidate is analytical, organized, and comfortable navigating the full revenue cycle from follow-up through resolution.

Responsibilities:

Claims Review & Resolution:

• Review, analyze, and resolve complex insurance claims including denials, underpayments, rejections, and payment discrepancies
• Research claims that require deeper investigation and determine the appropriate course of action
• Prepare and submit corrected claims, appeals, reconsiderations, and formal payer disputes as needed

Accounts Receivable & Follow-Up:

• Monitor outstanding accounts receivable and prioritize follow-up based on claim age, payer requirements, and reimbursement impact
• Communicate directly with Medicaid, Medicare, managed care organizations, commercial insurance plans, and other payers to resolve outstanding issues
• Maintain a proactive approach to follow-up to minimize aging and revenue loss

Process Improvement:

• Identify recurring billing errors, denial trends, and workflow gaps
• Recommend and support solutions to reduce future denials, rejections, and delays
• Maintain accurate documentation and ensure compliance with payer guidelines and PHI confidentiality requirements

---

Requirements:

• High school diploma or equivalent required
• Prior experience in medical billing, insurance claims, or healthcare revenue cycle preferred
• Working knowledge of medical billing procedures, insurance guidelines, CPT and HCPCS codes, and claim adjustment processes preferred
• Experience with electronic claims systems and payer portals a plus
• Strong analytical and problem-solving skills with a high attention to detail
• Excellent written and verbal communication skills
• Ability to manage multiple priorities, meet deadlines, and handle protected health information with discretion

 

Apply Now