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Job Description

Job Summary

Optimal Revenue Cycle Management Solutions, LLC (Optimal RCMS) is a rapidly growing medical billing company and we are actively expanding our team; we are looking for an experienced medical billing specialist to join our team. We strive for excellence in service and work as a close partner with our clients. Candidate must be detail oriented, motivated and customer service focused. This position will provide candidates with a great opportunity for a career that offers room for growth and advancement. As a medical billing specialist, you will work closely with our billing team to properly code, bill and work aging within a dedicated time frame.

Responsibilities and Duties

* Bill out medical claims for multiple provider specialties based on contractual methodologies and Division of Financial Regulatory Legislation
* Run weekly billing and aging reports from our Practice Management Software
* Review claims in the EMR for accuracy and proper coding
* Experience with UB04 and CMS 1500 forms, via EDI, single or batch claims and paper when necessary
* Update and correct claims rejects as necessary to ensure claims are received by the clearinghouse and payor in a timely manner
* Accurate payment and adjustment posting
* Follow-up with insurance companies and patients, as needed, to determine status of outstanding claims and collect payments
* Reconciliation of denied claims and underpayments, both professional and facility, utilizing insurance web portals to determine claim status; identify and submit patient records as needed to get claims paid
* Review and send patient statements monthly; work with physicians as needed to ensure accuracy of statements


* 3+ years of experience in medical billing, preferably with supervisory experience
* Experience in and knowledge of all medical billing protocols including HCPCS, ICD-10, CPT codes, modifiers, Revenue Codes, EOB’s and ERA’s
* EMR and system experience with KIPU, Lytec and Accucare a plus
* Knowledge of and experience with adhering to all HIPAA regulations
* Experience working in multiple billing systems preferred


* Proficiency in self-management; ability to set and meet/exceed goals for the medical billing department
* Ability to work as a member of a team and follow instruction
* Excellent communication skills (oral and written); excellent phone etiquette and ability to maintain strict HIPAA compliance
* Ability to communicate at appropriate level and with understanding of perspectives with insurance companies, facilities, providers and patients
* Database management of provider, health plan and patient records
* Demonstrated ability to handle multiple assignments and to collaborate effectively across an organization
* Proven attention to detail with maximum accuracy; strong analytical skills to determine best practices
* Strong Microsoft Office skills (Outlook, Word, Excel, Office365); EMR system experience
* Ability to maintain professional demeanor at all times and to exercise good judgement in working with patients and physicians

Required experience

* Medical Billing: 3 to 5 years
* Database management of health plan, provider and member records
* Ability to identify and resolve claims rejects
* Payment and Adjustment posting

Job Type: Full-time