Medicare Billing Specialist

Insight Global is seeking a Medicare Billing Specialist to join their clients team. The Medicare Billing Specialist is responsible for the accurate preparation, submission, and reconciliation of Medicare claims for outpatient mental health services. This role ensures compliance with Medicare regulations and supports the clinic’s financial health through timely claims processing, payment posting, denial management, and collaboration with providers to maintain accurate documentation.

Key Responsibilities:
• Prepare, review, and submit Medicare claims (CMS-1500) for outpatient mental health services.
• Apply correct CPT, HCPCS, and ICD-10 codes in compliance with Medicare rules.
• Ensure documentation meets “medical necessity” requirements.
• Track claim submission deadlines to meet Medicare’s timely filing requirements.
• Post Medicare remittances (EOBs/ERAs) to patient accounts.
• Reconcile accounts and resolve payment discrepancies.
• Identify underpayments and coordinate appeals or resubmissions.
• Maintain current knowledge of CMS and Medicare guidelines for outpatient mental health.
• Ensure provider documentation supports all billed services.
• Audit claims to minimize risk of denials or audits.
• Investigate and resolve denied or rejected claims.
• Prepare appeals with supporting documentation as needed.
• Track denial trends and recommend process improvements.
• Provide monthly Medicare billing and collection reports to management.
• Coordinate with front desk, eligibility staff, and clinical providers to ensure accurate patient insurance data.
• Educate staff on Medicare requirements as needed.
• Assist with other billing department functions as required.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

• High school diploma or equivalent; Associate or Bachelor’s degree in business or healthcare administration preferred.
• 2+ years of experience specifically in Medicare billing.
• Knowledge of CMS 1500 claims, CPT/HCPCS coding, ICD-10, and Medicare fee schedules.
• Familiarity with EHR/billing platforms (Valant preferred, Epic otherwise) and clearinghouse systems.
• Detail-oriented with strong analytical, communication, and problem-solving skills.
• HIPAA compliance knowledge and ability to manage sensitive information.

Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.