Location: Onsite (Rawalpindi)

Job Type: Full-Time

Department: Revenue Cycle Management (RCM)

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Position Overview

The Medical Billing Specialist is responsible for preparing and submitting clean claims to insurance companies, ensuring accurate charge entry, verifying benefits, correcting billing errors, and supporting the overall revenue cycle workflow. This role requires deep understanding of CPT/ICD codes, payer policies, and U.S. medical billing best practices.

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Key Responsibilities

1. Charge Entry & Claims Submission

• Enter charges accurately based on provider documentation (superbills, encounter notes).
• Verify coding completeness and ensure CPT, ICD-10, and modifiers are applied accurately.
• Submit clean claims to Medicare, Medicaid, commercial payers, and clearinghouses (Waystar, Trizetto, Availity).
• Correct claim rejections promptly from clearinghouses or payers.

2. Insurance Eligibility & Benefits Verification

• Verify insurance coverage, copays, deductibles, and plan-specific requirements.
• Document eligibility findings and communicate discrepancies to the provider or front desk team.
• Manage prior authorizations (if required by specialty).

3. Denial Prevention & Quality Checks

• Review encounters for missing documentation, coding errors, demographic issues, or eligibility problems.
• Proactively identify trends that may lead to denials (e.g., credentialing issues, incomplete charts).
• Coordinate with Coding, AR, and Credentialing teams to prevent recurring errors.

4. Payment Posting Support (if required)

• Assist in posting ERAs/EOBs into the billing system.
• Report payment variances or payer issues to the Team Lead.
• Ensure correct adjustments and write-offs follow company policy.

5. Documentation & Reporting

• Maintain accurate record-keeping for claims, rejections, and submissions.
• Provide daily/weekly updates on claim status, rejection trends, and workload progress.
• Track productivity KPIs such as charge entry accuracy and claim acceptance rates.

6. Communication & Coordination

• Work closely with providers, coders, AR specialists, and practice managers to resolve missing or incorrect information.
• Communicate professionally with insurance representatives when needed.
• Support credentialing or enrollment checks related to claim submission issues.

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Required Skills & Qualifications

• 1–3 years of experience in U.S. medical billing (mandatory).
• Strong understanding of CPT, ICD-10, HCPCS codes, and payer-specific billing rules.
• Experience with EMR/EHR systems such as eClinicalWorks, CareCloud, DrChrono, AdvancedMD, or Athena (preferred).
• Familiarity with clearinghouses (Waystar, Trizetto, Availity, Office Ally).
• Excellent communication skills (verbal & written).
• High accuracy, attention to detail, and strong problem-solving skills.
• Ability to manage high-volume work efficiently.
• Basic understanding of HIPAA requirements and patient privacy.

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Preferred Qualifications

• Experience working with multispecialty practices (Internal Medicine, OB/GYN, Urgent Care, Endocrinology, etc.).
• Understanding of insurance guidelines for Medicare, Medicaid, BCBS, UHC, Aetna, Cigna, etc.
• Knowledge of claim lifecycles (from charge entry → submission → adjudication).
• Strong analytical skills for troubleshooting rejections and errors.

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KPIs / Performance Expectations

• High clean claim rate at first submission (95%+).
• Low rejection/error rate.
• Daily charge posting accuracy above organizational standards.
• Timely submission of claims within 24–48 hours of receiving charges.
• Zero HIPAA violations.

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Benefits

• Competitive salary package.
• Monthly performance-based bonuses.
• Health/medical allowance (if applicable).
• Growth opportunities (Senior Biller → Team Lead → Assistant Manager).
• Continuous training and skill development.

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How to Apply

Please send your updated CV to hr@genmeditech.comwith the subject line:
“Medical Billing Specialist – [Your Name]”