Medical Billing Specialist at Southwest Women's Oncology in Albuquerque, NM, USA

Job description

• Behind every clinical encounter is a billing workflow that either works - or doesn't.
• When it works, patients aren't blindsided. Claims are clean. Revenue flows. The practice can focus on care.
• When it doesn't, the consequences ripple outward: delayed reimbursements, patient frustration, compliance exposure, and revenue the practice never recovers.
• The Medical Billing Specialist is the person who makes it work. With precision, ownership, and a genuine commitment to doing right by patients and the practice alike.
• We hold billing to the same standard as clinical care - because the financial experience is part of the patient experience. We hire for attitude and aptitude above all else. Credentials matter, but who you are and how you grow matter more.
• This is not a passive data-entry role. You will own the full billing cycle for a high-volume oncology and specialty practice-working with precision and urgency across claims, denials, payer relationships, and patient accounts.
• You will be a critical link between clinical care and financial performance, partnering with:
• Clinical and front office teams to ensure clean claims from point of service
• Third-party payers, government programs, and managed care plans
• The Patient Financial Advocate to support patient-facing financial resolution
• Leadership to identify trends, resolve systemic issues, and optimize revenue cycle performance
• Your accuracy, follow-through, and ownership will directly shape the financial health of the practice-and the experience of every patient whose account crosses your desk.
• First 90 Days
• Independently managing claims submission, follow-up, and denial resolution.
• Demonstrating working knowledge of payer requirements, billing workflows, and compliance standards.
• Building trust with clinical teams, front office staff, and billing leadership.
• Consistently delivering accurate, timely documentation and account management.
• First 6 Months
• Recognized as a reliable, high-accuracy contributor within the billing team.
• Proactively identifying denial trends and contributing to workflow improvements.
• Handling complex payer disputes and appeals with confidence and thoroughness.
• First Year
• Viewed as a culture carrier and billing anchor on the team.
• Measurably contributing to clean claim rates, denial reduction, and collections performance.
• Consistently embodying the Optimum Standard.
• We want people who bring relentless positivity, a hunger to learn, and the drive to elevate everyone around them. You will likely thrive if:
• You take ownership rather than waiting for direction.
• You believe details matter.
• You enjoy solving problems and seek continuous improvement.
• You care deeply about patients and their families.
• You value teamwork and accountability equally.
• You're coachable, curious, and committed to mastery.

Responsibilities

• Claims Management & Reimbursement
• Submit clean, accurate claims to insurance carriers, government payers, and third-party administrators in a timely manner.
• Actively follow up on delinquent and pending insurance claims to ensure timely resolution.
• Investigate and resolve claim discrepancies, denials, and underpayments; prepare and submit appeals with supporting documentation.
• Apply strong knowledge of posted charges, payments, and adjustments to maintain accurate account records.
• Insurance & Precertification
• Perform insurance verification and precertification for scheduled procedures and treatments.
• Ensure compliance with CMS billing guidelines and payer-specific requirements.
• Maintain current knowledge of third-party insurance, government payer rules, and physician billing and reimbursement processes.
• Patient Account Management
• Oversee patient accounts, including outstanding balances, collections workflows, and payment plan administration.
• Address patient inquiries regarding billing, insurance, and payment concerns with empathy and professionalism.
• Collaborate with the Patient Financial Advocate to support patients navigating complex financial situations.
• Compliance & Documentation
• Maintain strict adherence to HIPAA and all applicable federal and state billing regulations.
• Document all billing activity, account updates, and payer communications accurately and completely.
• Support audit readiness through organized, complete, and current account records.
• Continuous Improvement
• Identify denial trends, billing errors, and workflow inefficiencies; recommend and implement corrective actions.
• Collaborate with the billing team and leadership to optimize revenue cycle performance.
• Raise the standard through your precision, your ownership, and your example.

Requirements

• Required
• Minimum 3 years of experience in medical billing.
• In-depth understanding of third-party insurance, government payers, and physician billing and reimbursement processes.
• Strong knowledge of posted charges, payments, and adjustments.
• Proven experience with insurance precertification and verification processes.
• Familiarity with CMS billing guidelines and compliance requirements.
• Proficiency in medical billing software, credit card payment processing, and Microsoft Office Suite.
• Professional, service-oriented communication skills for handling patient and payer interactions.
• Oncology or specialty practice billing experience.
• Experience working with patient advocacy programs and financial assistance workflows.
• Familiarity with chemotherapy drug billing and specialty reimbursement processes.

Skills

Required

• Medical billing
• Third-party insurance knowledge
• Government payer knowledge
• CMS billing guidelines
• Medical billing software
• Credit card payment processing
• Microsoft Office Suite
• Professional communication
• Service-oriented communication

Preferred

• Oncology billing
• Specialty practice billing
• Patient advocacy programs
• Financial assistance workflows
• Chemotherapy drug billing
• Specialty reimbursement processes

Benefits

• Competitive salary
• Health benefits
• 401(k)
• Paid time off
• Professional development and continuing education support
• Opportunity to grow within the Optimum Platform