Prebill Claims Specialist

Job Type: Full-Time, Monday–Friday
Hours: 8:00 AM – 5:00 PM
Pay Rate: $18–$20/hour, based on experience

Position Overview

Trinity Employment Specialists is seeking a Prebill Claims Specialist to join a busy medical billing team. This position is responsible for reviewing patient accounts prior to claim submission, resolving billing edits, verifying patient and insurance information, and assisting with patient account balances. The ideal candidate will be detail-oriented, organized, and knowledgeable about medical billing and revenue cycle processes.

Key Responsibilities

Claim Review & Edits

• Review patient accounts and claims prior to submission to insurance payers.
• Identify and resolve prebill edits, including missing or invalid CPT and ICD-10 codes, NPI information, demographic discrepancies, and insurance corrections.
• Ensure claims are accurate and complete before submission.

Data Verification

• Verify patient demographics, insurance eligibility, and dates of service.
• Verify ordering and rendering provider information.
• Maintain accurate claim notes and documentation for auditing purposes.
• Follow HIPAA and patient confidentiality requirements.

Billing & Revenue Cycle

• Work with billing staff to resolve claim issues and obtain missing or corrected information.
• Utilize payer portals and clearinghouse systems to verify insurance and claim information.
• Monitor claim edit trends and assist with timely resolution to help meet filing deadlines.
• Escalate recurring issues to billing management for process improvement.

Patient Accounts / A/R

• Contact patients regarding outstanding balances and explain EOBs and patient responsibility.
• Process return mail and update patient addresses and demographic information.
• Assist with additional accounts receivable duties as needed to support timely collection of outstanding balances.

Qualifications

• Previous experience in medical billing, claims processing, prebill edits, or revenue cycle management preferred.
• Knowledge of medical billing practices, insurance verification, and claim requirements.
• Experience using payer portals and/or clearinghouse systems.
• Familiarity with medical billing software; laboratory or pathology billing experience is a plus.
• Strong attention to detail and analytical/problem-solving skills.
• Ability to work independently, prioritize tasks, and meet deadlines.
• Excellent written and verbal communication skills.
• Strong customer service skills.
• Ability to maintain confidentiality and comply with HIPAA regulations.

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