Medical Billing and Claims Specialist

Benefits:

• Bonus based on performance
• Opportunity for advancement
• Paid time off
• Location:

Pediatric Cardiology Consultants of South Texas (PCCST)

Job Summary:

The Billing and claims Specialist will play a critical role in managing the administrative and financial aspects of patient visits. The ideal candidate will provide excellent customer service, manage patient check-in/check-out, prior authorizations and handle billing tasks. This role also requires a detail-oriented individual who can manage patient accounts, verify insurance, and ensure the timely processing of claims and payments.

Key Responsibilities:

• Front

Desk Duties:

• Greet patients warmly and ensure a positive and professional experience.
• Manage patient check-in and check-out processes efficiently.
• Schedule patient appointments and follow-ups based on physician availability and patient needs.
• Maintain the reception area, keeping it clean, organized, and welcoming.
• Patient Information & Account Management:
• Update and maintain patient demographics by collecting personal and financial information.
• Verify insurance coverage and confirm eligibility prior to patient appointments.
• Explain insurance coverage to patients, including out-of-pocket costs, co-pays, and deductibles.
• Collect outstanding balances, co-pays, deductibles, and previous balances as needed.
• Billing & Insurance Processing:
• Manage billing processes and send claims to insurance companies using EMR (Athena).
• Handle prior authorizations and ensure all required documentation is submitted accurately.
• Communicate with insurance payers to ensure timely processing of claims and resolution of issues.
• Post charges, collections, and payments into the computer system and close daily batches.
• Monitor and follow up on unpaid claims, denials, or payment discrepancies to ensure timely reimbursement.
• Provide patients with detailed explanations of their bills, including procedures not covered by insurance.
• General Administrative Duties:
• Answer incoming phone calls, manage emails, and respond to patient inquiries regarding appointments, billing, or general clinic information.
• Assist in coordinating care with physicians, MAs, nurses, and other clinic staff.
• Ensure all patient documentation is completed accurately and filed appropriately.
• Participate in daily, weekly, or monthly meetings to review clinic operations, billing, and patient satisfaction metrics.

Qualifications:

• High school diploma or equivalent; additional education in healthcare administration or billing is a plus.
• Experience in a medical front office role
• Experience with Athena EMR is a plus
• Proficiency with billing, and claims management.
• Strong understanding of insurance verification, prior authorizations, and claims processing.
• Excellent communication and interpersonal skills with a patient-centric approach.
• Strong organizational skills and attention to detail.
• Ability to handle confidential information with professionalism.

Job Type: Full-time

Schedule:

• 8 hour shifts
• Monday to Friday

Education:

High school diploma or higher

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