Billing Specialist

The Billing Specialist plays a critical role in ensuring accurate claim processing, timely reimbursement, and effective accounts receivable management across Zarminali Pediatrics’ multi-state clinical footprint. This position requires advanced knowledge of pediatric billing, Medicaid managed care rules, payer policies, and coding accuracy. You will be responsible for moving claims efficiently through the revenue cycle by proactively identifying issues, resolving denials, monitoring payer activity, and coordinating with billing, coding, credentialing, and clinical teams. High accuracy, strong analytical skills, and consistent follow-through are essential to success in this role.

Claims Processing & Submission Prepare, review, and submit claims through Athena and clearinghouse Verify accuracy of demographics, insurance coverage, charge details, coding, modifiers, and Monitor and resolve claim edits, clearinghouse rejections, and payer error reports with same-day or next-day turnaround.

Prepare, review, and submit claims through Athena and clearinghouse

Verify accuracy of demographics, insurance coverage, charge details, coding, modifiers, and

Monitor and resolve claim edits, clearinghouse rejections, and payer error reports with same-day or next-day turnaround.

Accounts Receivable & Follow-Up Perform daily AR follow-up on outstanding claims across Medicaid, managed Medicaid, commercial plans, and third-party administrators. Investigate and resolve payer issues including eligibility conflicts, COB problems, primary/secondary discrepancies, and refund requirements. Review payments, adjustments, and write-offs; identify underpayments and initiate payer follow-up as needed.

Perform daily AR follow-up on outstanding claims across Medicaid, managed Medicaid, commercial plans, and third-party administrators.

Investigate and resolve payer issues including eligibility conflicts, COB problems, primary/secondary discrepancies, and refund requirements.

Review payments, adjustments, and write-offs; identify underpayments and initiate payer follow-up as needed.

Denial Management & Resolution Conduct root-cause analysis for claim denials and rejections.

Conduct root-cause analysis for claim denials and rejections.

Correct coding, demographic, or payer-sequencing issues and submit corrected

Prepare appeals, reconsiderations, and supporting documentation when

Collaborate with coding, credentialing, and revenue cycle leadership to address recurring denial trends or workflow gaps.

Patient Billing Support Handle patient statements, payment plan setup, and explanation of benefits Resolve patient billing inquiries with professionalism, clarity, and

Handle patient statements, payment plan setup, and explanation of benefits

Resolve patient billing inquiries with professionalism, clarity, and

Reporting & Compliance Contribute to month-end close processes including AR status updates, denial trend summaries, and backlog reporting. Ensure full compliance with payer rules, Medicaid regulations, documentation standards, and organizational billing policies.

Contribute to month-end close processes including AR status updates, denial trend summaries, and backlog reporting.

Ensure full compliance with payer rules, Medicaid regulations, documentation standards, and organizational billing policies.

Other Duties as assigned

3+ years of medical billing and AR experience; pediatric or multi-specialty experience strongly

Strong understanding of CPT, ICD-10, HCPCS, NCCI edits, and proper modifier usage—especially for pediatrics, vaccines, behavioral health, and therapy services.

Deep knowledge of Medicaid and managed Medicaid billing requirements, denial codes, filing timelines, and documentation prerequisites.

Experience working in Athena EMR / AthenaOne, particularly charge review worklists, claim edits, encounter status, and payer configurations.

Excellent problem-solving skills with the ability to resolve complex billing issues

Strong written and verbal communication skills for interacting with patients, payers, and internal

Ability to manage multiple priorities, meet deadlines, and maintain accuracy in a high-volume

Experience supporting multi-state pediatric practices or high-volume specialty

Familiarity with credentialing workflows and how credentialing issues affect