Prebill Claims Specialist

Job Title: Prebill Claims Specialist
Employment Type: Full-Time | Monday–Friday | 8:00 AM – 5:00 PM
Pay Rate: $18–$20/hour (based on experience)

Position Overview

We are seeking a detail-oriented Prebill Claims Specialist to join our billing team. This role is responsible for reviewing patient accounts before claim submission, resolving billing edits, verifying data accuracy, and assisting with patient account balances. The ideal candidate will have strong problem-solving skills, knowledge of medical billing practices, and the ability to work independently in a fast-paced environment.

Key Responsibilities

Claim Review & Edits

• Review patient accounts in the billing system before submission to payers.
• Identify and resolve prebill edits such as missing/invalid CPT, ICD-10, NPI, demographic mismatches, and insurance corrections.

Data Verification

• Verify patient demographics, insurance eligibility, and dates of service.
• Ensure ordering and rendering provider information is accurate.
• Maintain accurate claim notes in the billing system for audit purposes.
• Follow HIPAA and confidentiality guidelines at all times.

Collaboration & Reporting

• Escalate recurring claim edit trends to billing management for process improvement.
• Communicate with staff regarding corrections to insurance and demographic information.
• Track and report claim edit trends and resolution times to meet timely filing requirements.

Patient Accounts (A/R)

• Contact patients to collect balances and explain EOB and patient responsibility.
• Work return mail and update patient addresses/demographics as needed.
• Complete additional A/R tasks as assigned to ensure balances are collected.

Qualifications & Skills

• Prior experience in medical billing, claim edits, or revenue cycle preferred.
• Knowledge of eligibility tools such as payer portals and clearinghouse systems.
• Familiarity with billing systems (lab/pathology experience a plus).
• Strong attention to detail and analytical skills.
• Ability to meet deadlines and work independently.
• Excellent communication and customer service skills.