Merit Health Wesley

Why Join Us?

• Be Valued for What You Bring to the Team - Competitive pay that rewards your hard work
• Benefits You Can Count On - Medical, dental, vision, and life insurance coverage
• Work Hard. Recharge Often. - Generous PTO and extended illness benefits
• Invest in Your Future - 401(k) with company match
• Grow With Us - Career development, learning opportunities, and advancement pathways
• We Invest in Your Success - Licensure and certification reimbursement
• Student Loan Support - Assistance available for eligible roles
• Your Wins Deserve Recognition - Employee rewards and recognition programs
• A Team You'll Love Working With - A collaborative, purpose-driven culture making a difference every day
• Additional Voluntary Benefits - Choose from options such as pet insurance, identity protection, and legal insurance.

Great people. Great benefits. Meaningful work. Join us and make an impact!

No weekends, No holidays, No Call

Hours of Operation: Monday - Friday 8:00am to 5:00pm

Job Summary

The Billing Specialist I is responsible for performing insurance claim processing, billing, and follow-up to ensure timely and accurate reimbursement. This position serves as the primary contact for insurance companies and other payers, researching and resolving claim issues while maintaining compliance with billing regulations and organizational policies.

Essential Functions

• Submits and processes claims accurately and efficiently, ensuring compliance with payer requirements and company policies.
• Communicates with insurance companies, patients, and other stakeholders to resolve billing inquiries and maintain account status.
• Reviews and reconciles credit balances, reclassifies revenue, and processes adjustments per transaction coding guidelines.
• Monitors and resolves claim denials and rejections, identifying trends and implementing corrective actions.
• Reviews and corrects claim filing edits based on payer requirements and electronic health record (EHR) system alerts.
• Maintains accurate documentation of all billing actions in the practice management system.
• Gathers, updates, and communicates billing policy changes, ensuring accessibility of up-to-date reference materials.
• Collaborates with management, clinic staff, and coding teams to ensure proper billing and collection procedures.
• Assists patients and insurance representatives with billing-related questions while maintaining professionalism.
• Ensures compliance with HIPAA regulations and maintains confidentiality of patient financial and medical information.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• 0-2 years of experience in medical billing, insurance claims processing, or revenue cycle management required

Knowledge, Skills and Abilities

• Knowledge of medical billing processes, insurance claim procedures, and payer policies.
• Strong understanding of healthcare revenue cycle operations and reimbursement methodologies.
• Proficiency in electronic health records (EHR) and practice management systems (e.g., Athena, Cerner, Ingenious Med).
• Ability to interpret explanation of benefits (EOBs), identify billing discrepancies, and take corrective action.
• Excellent communication and interpersonal skills to interact with patients, providers, and payers professionally.
• Strong analytical and problem-solving abilities to research and resolve billing issues.
• Attention to detail and ability to manage multiple tasks while meeting deadlines.
• Working knowledge of HIPAA regulations and the importance of maintaining patient confidentiality.

Licenses and Certifications

• CPB- Certified Medical Biller issued by AAPC preferred or
• Certified Medical Insurance Specialist (CMIS) issued by PMI preferred

This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for an employer.