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Medical Billing and Claims Specialist

PEDIATRIC CARDIOLOGY CONSULTANTS OF SOUTH TEXAS

LIVE OAK, TX

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JOB DETAILS
SKILLS
Administrative Skills, Billing, Calendar Management, Cardiology, Claims Management, Claims Processing, Co-Payments, Communication Skills, Computer Systems, Customer Support/Service, Detail Oriented, Documentation, Electronic Medical Records, Email Management/Administration, Health Education, Healthcare Administration, High School Diploma, Insurance, Insurance Claims, Interpersonal Skills, Medical Billing, Medical Office, Medical Records, Metrics, Nursing, Operational Audit, Organizational Skills, Patient Assessment, Patient Follow-up, Pediatrics, Problem Solving Skills, Process Management, Reconciliation, Reimbursement, Sales Management, Telephone Skills, Time Management
LOCATION
LIVE OAK, TX
POSTED
8 days ago
Benefits:
  • Bonus based on performance
  • Opportunity for advancement
  • Paid time off


Location: Pediatric Cardiology Consultants of South Texas (PCCST)


Job Summary:
The Billing and claims Specialist will play a critical role in managing the administrative and financial aspects of patient visits. The ideal candidate will provide excellent customer service, manage patient check-in/check-out, prior authorizations and handle billing tasks. This role also requires a detail-oriented individual who can manage patient accounts, verify insurance, and ensure the timely processing of claims and payments.


Key Responsibilities:


  1. Front Desk Duties:
    • Greet patients warmly and ensure a positive and professional experience.
    • Manage patient check-in and check-out processes efficiently.
    • Schedule patient appointments and follow-ups based on physician availability and patient needs.
    • Maintain the reception area, keeping it clean, organized, and welcoming.
  2. Patient Information & Account Management:
    • Update and maintain patient demographics by collecting personal and financial information.
    • Verify insurance coverage and confirm eligibility prior to patient appointments.
    • Explain insurance coverage to patients, including out-of-pocket costs, co-pays, and deductibles.
    • Collect outstanding balances, co-pays, deductibles, and previous balances as needed.
  3. Billing & Insurance Processing:
    • Manage billing processes and send claims to insurance companies using EMR (Athena).
    • Handle prior authorizations and ensure all required documentation is submitted accurately.
    • Communicate with insurance payers to ensure timely processing of claims and resolution of issues.
    • Post charges, collections, and payments into the computer system and close daily batches.
    • Monitor and follow up on unpaid claims, denials, or payment discrepancies to ensure timely reimbursement.
    • Provide patients with detailed explanations of their bills, including procedures not covered by insurance.
  4. General Administrative Duties:
    • Answer incoming phone calls, manage emails, and respond to patient inquiries regarding appointments, billing, or general clinic information.
    • Assist in coordinating care with physicians, MAs, nurses, and other clinic staff.
    • Ensure all patient documentation is completed accurately and filed appropriately.
    • Participate in daily, weekly, or monthly meetings to review clinic operations, billing, and patient satisfaction metrics.
Qualifications:
  • High school diploma or equivalent; additional education in healthcare administration or billing is a plus.
  • Experience in a medical front office role
  • Experience with Athena EMR is a plus
  • Proficiency with billing, and claims management.
  • Strong understanding of insurance verification, prior authorizations, and claims processing.
  • Excellent communication and interpersonal skills with a patient-centric approach.
  • Strong organizational skills and attention to detail.
  • Ability to handle confidential information with professionalism.

Job Type: Full-time


Schedule:
  • 8 hour shifts
  • Monday to Friday
Education:


  • High school diploma or higher 

About the Company

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PEDIATRIC CARDIOLOGY CONSULTANTS OF SOUTH TEXAS