Medical Billing Specialist

Company Description Practice Pathways RCM is a healthcare revenue cycle management organization dedicated to improving financial performance for medical practices. The team focuses on accurate, timely billing and claims management to help providers maintain strong cash flow and reduce administrative burden. Using standardized processes and technology, the company supports practices with insurance verification, coding, and payment posting. Summus Healthcare–Practice Pathways RCM values collaboration, accountability, and high-quality service for both clients and patients.
Role Description The Medical Billing Specialist role is a full-time remote position responsible for managing the end-to-end billing process for healthcare providers. Day-to-day tasks include submitting insurance claims, reviewing and reconciling payments, identifying and resolving billing errors, and following up on unpaid or denied claims. The specialist will verify patient insurance coverage, ensure appropriate use of ICD-10 codes, and adhere to payer-specific and Medicare billing guidelines. The role also involves maintaining accurate documentation, communicating with insurance companies and practice staff, and helping optimize reimbursement and reduce denials.
Qualifications
Strong knowledge of Medical Terminology and healthcare billing processes.
Experience working with Denials management, including review, appeal, and resolution.
Proficiency in ICD-10 coding and understanding of coding standards and compliance.
Working knowledge of commercial Insurance policies, reimbursement rules, and payer requirements.
Familiarity with Medicare billing regulations and guidelines.
Prior experience as a medical billing or revenue cycle specialist in a healthcare setting.
Ability to work accurately with high volumes of data, with strong attention to detail and organization.
Effective written and verbal communication skills for interacting with payers and practice staff.
Comfort with using billing software, electronic health records (EHR), and standard office applications.
High school diploma or equivalent required; additional coursework or certification in medical billing/coding is preferred.

Work arrangement
Yes