Billing Associate - Shenandoah - Pediatrix Medical Group

Description

OverviewResponsibilitiesThe Billing Associate is responsible for ensuring the accurate and timely processing of billing and medical claims within the ambulatory practice setting.

This role supports the revenue cycle by verifying insurance coverage, posting charges,submitting clean claims, reviewing front-end denials, and posting time-of-service payments.

The Billing Associate collaborates closely with Corporate RCM, clinical teams, and administrative staff to ensure compliance with payer guidelines and corporate policies.

60;Charge Entry and Claims Processing
Review reports, encounter forms, fee tickets, and medical records to accurately capture, enter or accept charges.
Verify patient and insurance information before claim submission.
Ensure all necessary documentation, authorizations, and codes are complete prior to claim submission.
Validate accuracy of CPT, ICD-10, and modifier codes before claim submission.
Post patient payments accurately in the practice management system.
Balance batches and reconcile payments against system reports.
Insurance Verification and AuthorizationVerify patient insurance eligibility and benefits prior to appointments or procedures.
Obtain and document pre-authorizations and referrals required for specialist services.
Communicate with patients and providers regarding coverage limitations and out-of-pocket costs.
Maintain updated knowledge of payer-specific requirements and medical necessity policies for specialty procedures.
Update patient records with accurate insurance and demographic information.
Patient Account SupportRespond to patient billing inquiries courteously and professionally.
Escalate billing discrepancies or issues to RCM as needed.
Billing Reports and ComplianceRun, review, and work all daily, weekly, and monthly billing reports.
Manage and resolve worklog tasks and claims manager edits, ensuring timely review, correction, and documentation.
Assist with internal audits and quality control reviews of billing data.
Participate in SOX review process and ensure unresolved items are addressed per policy.
Ensure billing practices comply with HIPAA, CMS, and payer-specific regulations.
Maintain confidentiality and secure handling of patient and financial data.
Stay current with coding updates (ICD-10, CPT, HCPCS) and insurance billing guidelines relevant to the specialty.

Collaboration and SupportIdentify trends in denials or claim errors and communicate recurring issues to the Billing Manager or Practice Administrator for process improvement.

Coordinate with front-desk staff and clinical teams to resolve billing-related issues.
Provide feedback to providers regarding documentation requirements for accurate billing.
Participate in departmental meetings and contribute to process improvement initiatives.
Assist with end-of-month reporting and reconciliation as needed.
Qualifications

Education:
High school diploma or equivalent required; associate's degree or certification in medical billing and coding preferred.

Experience Industry:
Healthcare


Experience:
2+ years of medical billing experience, preferably in a specialist or ambulatory practice setting
Working knowledge of CPT, ICD-10, and HCPCS coding required
Strong understanding of commercial and government payer policies and claim workflows required
Proficiency with electronic health record (EHR) and practice management preferred

Skills/Abilities:
Excellent attention to detail, analytical, and problem-solving skills
Effective communication and customer service abilities
Benefits and CompensationTake great care of the patient, every day and every way.

TMAt Pediatrix & Obstetrix, that's not only our motto at work each day; it's also how we view our employees and their families.

We know that our greatest asset is YOU.

60;We take pride in offering comprehensive benefits in a vast array of plans that fit your life and lifestyle, supporting your health and overall well-being.

Benefits offered include, but are not limited to:

Medical, Dental, Vision, Life, Disability, Healthcare FSA, Dependent Care FSA and HSAs, as well as a 401k plan and Employee Stock Purchase Program.

60;Some benefits are provided at no cost, while others require a cost share between employees and the company. Employees may also select voluntary plans and pay for these benefits through convenient payroll deductions.

60;Our benefit programs are just one of the many ways Pediatrix & Obstetrix helps our employees take care of themselves and their families.

60;

About UsPediatrix Medical Group is one of the nation's leading providers of highly specialized health care for women, babies and children.

Since 1979, Pediatrix has grown from a single neonatology practice to a national, multispecialty medical group.

Pediatrix-affiliated clinicians are committed to providing coordinated, compassionate and clinically excellent services to women, babies and children across the continuum of care, both in hospital settings and office-based practices.

The group's high-quality, evidence-based care is bolstered by significant investments in research, education, quality-improvement and safety initiatives.


60;Please Note:
Fraudulent job postings/job scams are becoming increasingly common.

All genuine Pediatrix job postings can be found through the Pediatrix Careers site: 60; .

Pediatrix is an Equal Opportunity EmployerAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.