JOB TITLE: MEDICAL BILLING SPECIALIST – ACCOUNTS RECEIVABLE
JOB SUMMARY:
At Nebraska Hematology-Oncology, we are committed to providing exceptional patient care by ensuring accurate and timely reimbursement for services provided. The Patient Financial Services team works collaboratively with patients, providers, insurance carriers, and internal departments to promote financial stewardship while supporting our mission of compassionate cancer care.
The Medical Billing Specialist – Accounts Receivable is responsible for the timely follow-up and resolution of outstanding insurance and patient accounts. This position manages accounts receivable by reviewing unpaid, denied, rejected, and underpaid claims, pursuing reimbursement through payer follow-up and appeals, and ensuring accurate documentation of all account activity. The Medical Billing Specialist works collaboratively with clinical and administrative staff to maximize reimbursement while providing excellent customer service and maintaining compliance with all payer regulations and organizational policies.
REPORTS TO: Patient Financial Services Supervisor
PRINCIPAL DUTIES:
- Review and manage assigned accounts receivable to ensure timely collection of outstanding balances.
- Follow up with commercial insurance companies, Medicare, Medicaid, and other third-party payers regarding unpaid, denied, or underpaid claims.
- Investigate claim denials and determine appropriate corrective actions, including claim corrections, appeals, rebilling, and submission of supporting documentation.
- Submit corrected claims and insurance appeals within payer filing deadlines.
- Analyze explanation of benefits (EOBs), remittance advice, and payer correspondence to identify payment discrepancies and resolve reimbursement issues.
- Accurately document all account activity, communications, and resolution efforts within the practice management system.
- Process approved account adjustments, write-offs, refunds, and payment corrections according to organizational policies.
- Communicate with patients regarding insurance processing, claim status, and account balances as appropriate.
- Collaborate with providers, clinical staff, patient financial advocates, and other Patient Financial Services team members to resolve billing issues affecting reimbursement.
- Identify recurring billing or payer issues and communicate trends to leadership for process improvement.
- Maintain current knowledge of payer guidelines, reimbursement policies, and regulatory changes affecting medical billing.
- Maintain strict confidentiality of patient information and comply with HIPAA and all applicable federal and state regulations.
- Meet departmental productivity, quality, and aging goals.
- Attend required meetings and participate in committees as requested.
- Perform other duties as assigned.
POSITION REQUIREMENTS:
EDUCATION AND EXPERIENCE:
- High school diploma or equivalent required.
- Associate degree in Healthcare Administration, Medical Billing and Coding, Business, or a related field preferred.
- Minimum of two years of professional medical billing experience with emphasis in accounts receivable management and insurance follow-up.
- Experience working with commercial insurance, Medicare, Medicaid, and managed care plans required.
- Knowledge of physician billing, revenue cycle management, insurance appeals, denial management, and claims processing.
- Experience with electronic practice management and billing systems preferred.
- Oncology or specialty practice experience preferred.
- Additional relevant experience may be considered in lieu of formal education.
TYPICAL PHYSICAL DEMANDS:
Work is primarily performed in an office environment requiring prolonged periods of sitting, computer use, and telephone communication. Frequent interaction with patients, insurance representatives, providers, and staff requires effective communication and the ability to manage multiple priorities. Work may be fast-paced and occasionally stressful due to productivity expectations and reimbursement deadlines.
PERFORMANCE:
- Provides accurate and timely follow-up on outstanding accounts to maximize reimbursement and minimize accounts receivable aging.
- Demonstrates knowledge of insurance billing guidelines, reimbursement methodologies, and denial resolution strategies.
- Maintains productivity and quality standards established by the Patient Financial Services department.
- Exercises sound judgment when researching and resolving complex billing and reimbursement issues.
- Demonstrates strong organizational skills and attention to detail while managing multiple priorities.
- Maintains professionalism and confidentiality in all patient and payer interactions.
- Communicates effectively with patients, providers, and coworkers while providing exceptional customer service.
- Demonstrates proficiency with practice management software, Microsoft Office applications, and electronic billing systems.
- Strong knowledge of medical terminology, CPT, ICD-10-CM, HCPCS coding principles, and HIPAA privacy regulations.
- Skill in identifying reimbursement issues, analyzing trends, and recommending process improvements.
- Ability to establish and maintain positive working relationships with patients, insurance representatives, providers, and fellow employees.
- Ability to interpret payer policies, explain billing information clearly, and adapt to changing reimbursement requirements.
