The Medical Billing Specialist – Physician Claims (Epic) is responsible for accurate and timely submission, follow-up, and resolution of professional (physician) claims using the Epic system. This role ensures clean claim submission, minimizes denials, and supports optimal reimbursement by adhering to payer guidelines, coding standards, and organizational policies.

Key Responsibilities

• Prepare, review, and submit physician (professional) claims through Epic work queues.
• Ensure claims are coded and billed accurately based on documentation, payer requirements, and regulatory guidelines.
• Monitor and resolve claim edits, rejections, and denials in Epic.
• Perform claim follow-up with insurance payers to ensure timely reimbursement.
• Investigate and correct billing discrepancies, including eligibility, authorization, and coding issues.
• Post and reconcile payments and adjustments as needed (if applicable).
• Identify trends in denials and recommend process improvements.
• Communicate effectively with coding teams, providers, and payers to resolve billing issues.
• Maintain compliance with HIPAA and all applicable billing regulations.
• Meet productivity and quality benchmarks set by the organization.

Required Qualifications

• High school diploma or equivalent (Associate’s or Bachelor’s degree preferred).
• 2+ years of experience in physician billing or medical billing.
• Hands-on experience with Epic (professional billing module).
• Strong knowledge of CPT, ICD-10-CM, and HCPCS coding systems.
• Familiarity with payer guidelines, including Medicare, Medicaid, and commercial insurers.
• Experience handling claim denials, appeals, and follow-ups.
• Proficiency in Microsoft Office (Excel, Word, Outlook).

Preferred Qualifications

• Certification such as CPC (Certified Professional Coder), CPB (Certified Professional Biller), or equivalent.
• Experience in multi-specialty physician billing.
• Knowledge of revenue cycle workflows and KPIs.

Performance Metrics

• Clean claim rate
• Days in Accounts Receivable (A/R)
• Denial rate and resolution turnaround time
• Productivity (claims processed per day)
• Quality and accuracy scores