Billing Specialist

| Department: | RCM | Supervises: | Sub-Department: | Corporate Support Center |

Reports To: | Billing Specialist | Date Completed: | 06/06/2025

General Position Description:

Ensure claim accuracy and high-quality customer service through review, correction, and resubmission of rejected and delinquent claims within timely filing limits.

Core Responsibilities:

• Review all assigned Practice Management claim errors, determine the appropriate action, correct and file all claims with error status
• Review all assigned Clearinghouse claim errors, determine the appropriate action, correct and file all claims with error status and note actions in patients' chart
• Review all assigned insurance payor rejections, determine the appropriate action, correct and re-file all rejected claims Review and maintain the Clearinghouse workgroup list, ensure the resubmission process is complete
• Ensure that all claims within assigned receivables meet timely filing requirements
• Assist management in identifying trends in rejection results with various insurance carriers
• Maintain current knowledge of assigned insurance carrier's rules and regulations both federal and commercial
• Ensure that month-end goals are met in a timely manner
• Work with clinic supervisors and staff to improve the capture and accuracy of demographic information as well as other information critical to claim processing and reimbursement
• Observe safety and security procedures; promote a safe and pleasant work environment
• Regular attendance to ensure efficient operations
• Assist in questions from other departments concerning rejections

Other duties and responsibilities:

• Other duties and responsibilities as assigned.

Qualifications:

• High school graduate or equivalent.
• Proven ability to work in a team environment.
• Articulate communication skills and excellent customer service skills.
• Computer knowledge, e.g., Microsoft Office. Accuracy and detail orientation with high level of productivity.
• Familiarity with ICD-10, and CPT coding, as well as experience reviewing and understanding insurance EOBs is preferred.

Physical Demands/Work Conditions:

• Office environment. Sitting and keyboarding for extended periods of time.
• High attention to detail and ability to focus. Moderate noise level.

PS: It's All About You!

American Family Care has pioneered the concept of convenient, patient-centric healthcare. Today, with more than 250 clinics and 800 in-network physicians caring for over 6 million patients a year, AFC is the nation's leading provider of urgent care, accessible primary care, and occupational medicine. Ranked by Inc. magazine as one of the fastest-growing companies in the U.S., AFC's stated mission is to provide the best healthcare possible, in a kind and caring environment, while respecting the rights of all patients, in an economical manner, at times and locations convenient to the patient.

If you are looking for an opportunity where you can make a difference in the lives of others, join us on our mission. We invite you to grow with us and experience for yourself the satisfying and fulfilling work that the healthcare industry provides.

Please note that a position may be for a company-owned or franchise location. Each franchise-owned and operated location recruits, hires, trains, and manages their own employees, sets their own employment policies and procedures, and provides compensation and benefits determined by that franchise owner. Company-owned locations provide a comprehensive benefits package including medical, dental, vision, disability, life insurance, matching 401(k), and more.

We are an Equal Opportunity Employer.