Medical Billing Specialist

Job Title

The Medical Billing Specialist will handle end-to-end billing processes in a fast-paced, multi-specialty physician environment. The ideal candidate must have strong analytical and problem-solving skills, be able to work independently, and possess in-depth knowledge of billing, coding, and payer guidelines. We are seeking a Medical Biller who can manage claims from submission through payment and resolution, with a strong focus on clean claims, follow-up, and customer service.

About Complete Care Partners, LLC

Complete Care Partners helps patients navigate their health alongside their physician, gaining peace of mind and increase quality of life. At Complete Care Partners we recognize the value in taking care of one’s health and the relationship between the patient and their doctors. Our mission is to help patients and their families not only understand their chronic conditions and healthcare plan provided by their doctors, but to also make sure that they have someone to count on to provide quality service and knowledge when they need help.

Description

Key Responsibilities

Claims and Billing Operations

• Prepare, review, and submit insurance claims (electronic and paper when needed) for professional and or facility services.
• Verify that claims include accurate patient demographics, insurance information, authorizations, diagnosis codes, procedure codes, modifiers, units, and supporting documentation as applicable.
• Maintain clean claim workflows and resolve claim edits and clearinghouse rejections promptly.

A/R Follow-Up and Denials Management

• Monitor accounts receivable aging and prioritize follow-up based on payer rules, dollar value, and timely filing limits.
• Investigate and resolve denials, underpayments, and request for information (medical records, referrals, authorizations).
• Submit corrected claims and appeals with appropriate documentation and accurate coding support.

Payments and Patient Billing

• Post and reconcile payments and adjustments from ERAs and EOBs.
• Identify and escalate payer payment variances and contract issues per internal workflow.
• Generate patient statements, respond to billing questions, and assist with payment plans when applicable.

Compliance and Documentation

• Maintain HIPAA compliance and protect PHI in all billing workflows.
• Document account actions clearly and consistently to support audit readiness and continuity.
• Follow payer policies and internal compliance expectations to prevent billing errors and reduce compliance risk.

Collaboration

• Coordinate with front desk, clinical staff, coding, and management to resolve missing information and prevent repeat denials.
• Communicate trends in denials, eligibility issues, and documentation gaps to improve upstream processes.

Required Qualifications

• High school diploma or equivalent (associate degree preferred).
• 1 to 3+ years of medical billing experience.
• Experience with UB-04 (CMS 1450) claim forms.
• Working knowledge of:
• Insurance eligibility and benefits verification
• Claim submission and rejection correction
• Denial management and appeals
• Payment posting and adjustments (ERA and EOB)
• A/R follow-up and payer portals
• Familiarity with ICD-10-CM, CPT, and HCPCS concepts (coding certification not required unless stated).
• Proficiency with billing software, clearinghouses, and Microsoft Excel.

Preferred Qualifications

• Experience with facility coding, including common payer requirements and authorization workflows.
• Experience with Medicare, Medicaid, and major commercial payers.
• Strong understanding of payer edits, bundling rules, modifiers, and medical necessity denials.
• Certification such as CPB, CPC, CCS, or similar.

Disclosures:

• This role involves handling protected health information (PHI) and requires strict compliance with HIPAA, CMS, and all organizational privacy and security standards.
• Job duties may be updated periodically based on regulatory changes, CCM program requirements, or internal policy adjustments.
• Enrollment quotas, productivity expectations, and performance metrics may be modified according to organizational needs.
• Continued employment requires completing all required organization training, maintaining accurate documentation, and meeting quality standards.
• The organization reserves the right to revise job expectations, responsibilities, or role requirements to support operational efficiency.
• We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or any other status protected under applicable federal, state, or local laws.
• This position is office on-site based in El Paso, Texas.