The Billing Specialist II is responsible for processing and auditing insurance claims, rebilling denied claims, and resolving billing discrepancies within the electronic claims management system. This role ensures accurate and timely claim submission, identifies and corrects billing errors, and maintains compliance with payer regulations and corporate policies. The Billing Specialist II demonstrates advanced knowledge of billing procedures, coding standards, and third-party payer requirements, serving as a mentor and resource for junior billing staff.

Essential Functions Processes and submits insurance claims via electronic and paper billing systems, ensuring accuracy, completeness, and compliance with payer-specific requirements.

Reviews system account displays to verify patient demographics, balances, and insurance information prior to claim generation, making necessary corrections.

Identifies and resolves claim errors, denials, and rejections, taking corrective action and rebilling claims within the required timeframe.

Monitors electronic billing processes, ensuring successful claim downloads, accurate transmission, and timely follow-up on failed claims.

Audits and assembles billing documentation, reviewing claims for completeness and applying modifications when needed to ensure proper reimbursement.

Demonstrates proficiency in revenue codes, HCPCS, CPT coding, and payer billing guidelines, ensuring accurate claims processing and compliance with regulations.

Responds to billing inquiries from internal departments and payers, providing resolution within two business days or escalating issues as needed.

Maintains knowledge of third-party billing regulations, payer requirements, and automated resources to improve billing efficiency and compliance.

Assists in mentoring and training junior billing staff, sharing expertise in claim resolution, billing requirements, and payer policies.

Communicates with other departments, including patient access, revenue cycle, and coding teams, to ensure accurate billing information and prevent claim errors.

Performs other duties as assigned.

Maintains regular and reliable attendance.

Complies with all policies and standards.

Qualifications H.S. Diploma or GED required

Associate Degree in Business, Healthcare Administration, Medical Billing, or a related field preferred

2-4 years of experience in medical billing, insurance claims processing, or revenue cycle operations required

Experience with hospital or physician billing, including payer policies, reimbursement processes, and electronic billing systems preferred

Knowledge, Skills and Abilities Advanced understanding of insurance claim processing, billing regulations, and reimbursement methodologies.

Proficiency in electronic claims management systems, revenue codes, and medical coding standards (HCPCS, CPT, UB-04, CMS-1500).

Strong problem-solving skills with the ability to analyze claim errors, identify trends, and implement corrective actions.

Experience with payer-specific guidelines, denial management, and appeals processes.

Ability to work independently and as a mentor to junior billing staff, demonstrating leadership and teamwork skills.

Proficiency in Microsoft Office Suite (Excel, Outlook, Word) and electronic health record (EHR) systems.

Strong written and verbal communication skills for interacting with payers, internal departments, and external partners.

Licenses and Certifications CPB- Certified Medical Biller preferred