Job Details

ABOUT LLCHC

Lower Lights Christian Health Center (LLCHC) transforms the overall health of Central Ohio, serving one individual at a time. We are focused on whole-person wellness, available to ALL in Central Ohio who need it, regardless of ability to pay! In 2019 alone, we served over 12,000 patients - with 40% being uninsured - and totaled 50,000+ medical encounters!

Operating out of seven locations, we offer medical care (primary care, dental, vision, OB/GYN, telehealth), behavioral health care, 340B pharmacy, nutritional assistance programs, and more. Working hours are Monday - Friday with occasional Saturday morning coverage.

SUMMARY:

The Medical Billing Specialist ensures accurate coding, timely claim submission, and efficient reimbursement for clinical services. This role reviews documentation, assigns codes, prepares and submits claims, follows up on denials, and maintains compliance with payer policies and HIPAA.

ESSENTIAL JOB RESPONSIBILITIES:

• Review clinical documentation and assign accurate ICD-10-CM, CPT, and HCPCS codes.

• Prepare, scrub, and submit clean claims to commercial, Medicare/Medicaid.

• Verify insurance eligibility/benefits and obtain prior authorizations as needed.

• Monitor claims status; research, correct, and resubmit denials/edits; post payments and adjustments.

• Manage patient billing: statements, payment plans, refunds, and resolution of billing inquiries.

• Reconcile daily charges, payments, and balances; escalate discrepancies.

• Maintain current knowledge of payer policies, NCCI edits, and regulatory updates.

• Protect PHI and uphold HIPAA and organizational privacy/security policies.

• Collaborate with providers, clinical staff, and revenue cycle team to optimize documentation and reimbursement.

Core Competencies

• Accuracy & Compliance (coding guidelines, HIPAA)

• Analytical Problem-Solving (EOB/ERA analysis, denial trends)

• Time Management & Prioritization

• Collaboration & Provider Education

• Professionalism & Patient Service

BENEFITS AND PERKS

• Health benefits including medical, vision, dental, life, disability
• Generous Paid Time Off
• 10 Paid Holidays
• Student loan forgiveness opportunities
• Employee Assistance Program (EAP) with access to various consultants
• 3% match toward retirement fund
• And more!

LIVING OUR VALUES

You are mission-oriented and passionate about living out your purpose. You play an active role in responding to the needs of the community and organization. You work well alongside your teammates and use your time and resources effectively. You challenge yourself to grow personally and professionally. You embrace diversity and enjoy providing your customers with excellent treatment and compassion.

Required Qualifications

• High school diploma or equivalent required.
• Active billing/coding certification.

• 1-3+ years of recent medical billing/coding experience in an outpatient, inpatient, or specialty setting.

• Proficiency with EHR/PM systems (e.g., Epic) and clearinghouses.

• Working knowledge of ICD-10-CM, CPT/HCPCS, modifiers, payer rules, and claims lifecycles (837/835).

• Strong understanding of denials management, aging A/R, and reconciliation.

• High attention to detail; ability to meet volume and accuracy targets.

• Excellent communication and customer service skills.

Preferred Qualifications

• Experience in [primary care, behavioral health, etc.]

• Familiarity with Medicare LCD/NCD guidance and state-specific Medicaid policies.

• Knowledge of risk adjustment (HCC), HEDIS-quality documentation, and prior auth workflows.