Medical Billing Specialist II

Medical Biller Location: In-Office (Cordova, TN) Department: Business Office / Revenue Cycle Management Experience Required: Minimum 5 years of relevant medical billing experience Preferred Specialty Experience: Outpatient Psychiatry / Behavioral Health Position Summary Health. Quest, P.C. is seeking an experienced Medical Biller to join our Business Office team.

This is a fully in-office position requiring a minimum of five (5) years of hands-on medical billing and revenue cycle experience , preferably within an outpatient psychiatric or behavioral health practice. The Medical Biller is responsible for supporting the full revenue cycle, including benefits investigations, charge entry and posting, payment posting, accounts receivable follow-up, claim aging, denial management, inpatient and outpatient billing, and credentialing.

The successful candidate must be able to work claims from beginning to resolution-not simply submit claims. This position requires strong knowledge of payer requirements, reimbursement rules, claim corrections, denials, and follow-up procedures.

Essential Duties and Responsibilities

Performing benefits investigations and eligibility verification , including reviewing coverage, copays, deductibles, coinsurance, authorization requirements, and other patient financial responsibilities. Accurately completing charge entry and charge posting and reviewing charges for completeness before claim submission.

Posting and reconciling insurance and patient payments , including ERA/EOB payments, adjustments, contractual allowances, secondary billing, recoupments, and other payer transactions. Reviewing claims for accuracy and ensuring clean claims are submitted to the appropriate payer. Managing accounts receivable (A/R) and routinely working aging reports to identify outstanding or underpaid claims.

Investigating and resolving claim denials, rejections, underpayments, and unpaid claims . Correcting billing errors and submitting corrected claims, reconsiderations, and appeals when appropriate. Following up with Medicare, Medicaid/Tenn. Care, commercial insurance companies, managed care organizations, and other third-party payers.

Identifying payer trends and recurring billing problems and escalating concerns to management when appropriate. Reviewing EOBs and ERAs to ensure claims have been processed according to applicable payer contracts and reimbursement requirements. Determining appropriate next steps when coverage is inactive, coordination-of-benefits issues exist, additional information is required, or a claim has been billed to an incorrect payer.

Processing secondary and tertiary claims when applicable. Performing both inpatient and outpatient professional billing . Maintaining accurate documentation of billing and follow-up activity within the practice management/EHR system. Assisting with provider credentialing and recredentialing , including payer applications, CAQH maintenance, enrollment documentation, follow-up, and tracking effective dates.

Communicating with patients when necessary to resolve insurance, eligibility, coordination-of-benefits, or patient-responsibility issues. Working collaboratively with clinical, front-office, and administrative staff to resolve issues affecting reimbursement. Maintaining compliance with HIPAA, payer requirements, organizational policies, and applicable federal and state billing regulations.

Required Qualifications Candidates must have: Minimum of five (5) years of relevant medical billing experience. Experience working within a physician or outpatient medical practice ; outpatient psychiatry or behavioral health experience is strongly preferred. Demonstrated experience with the complete revenue cycle, including: Benefits investigations and eligibility Charge entry Charge posting Payment posting Accounts receivable and aging Denial management Claim follow-up and appeals Inpatient professional billing Outpatient professional billing Provider credentialing Strong working knowledge of Medicare and Medicaid/Tenn.

Care billing and reimbursement requirements . Strong knowledge of commercial insurance billing requirements . Familiarity with major Tennessee insurance carriers and managed care organizations . Ability to interpret EOBs, ERAs, payer correspondence, eligibility responses, and denial/rejection messages. Knowledge of CPT, ICD-10-CM, HCPCS, modifiers, payer edits, coordination of benefits, and general claims-processing requirements.

Ability to identify billing errors and independently research and resolve claim issues. Strong attention to detail, organization, documentation, and follow-through. Ability to manage multiple payer issues and outstanding claims while meeting established productivity and accuracy expectations. Strong computer skills and experience working with electronic health record and practice-management/revenue-cycle systems.

Preferred Qualifications

Five or more years of billing experience specifically within psychiatry, behavioral health, or another outpatient specialty practice . Experience billing psychiatric evaluation, medication-management, behavioral health, and related professional services. Experience with Greenway Intergy or comparable EHR/practice-management systems .

Experience with Availity and payer-specific provider portals. Experience handling Medicare crossover claims, Medicaid managed-care claims, recoupments, appeals, and payer audits. Experience credentialing physicians and advanced practice providers. Position Expectations This position requires an experienced biller who can independently manage assigned responsibilities and recognize when a claim requires additional investigation or action.

The Medical Biller is expected to demonstrate a high level of accuracy, follow established billing procedures, meet departmental deadlines, maintain timely follow-up on outstanding claims, and communicate potential revenue-cycle problems to management. Because accurate billing directly affects the financial performance of the practice, the successful candidate must demonstrate accountability, attention to detail, urgency, and consistent follow-through .

Work Arrangement: This is an in-office position. Remote work is not available for this role.