Government healthcare programs, such as Medicare, Medicaid, and the VA healthcare system, require meticulous financial oversight and compliance with federal regulations. Medical Billing/Account Management Specialists ensure that claims are processed accurately, payments are managed efficiently, and government agencies remain compliant with healthcare billing regulations.

What does a Medical Billing/Account Management Specialist do on Government Contracts?

A Medical Billing/Account Management Specialist plays a crucial role in ensuring that government healthcare programs operate efficiently. Their key responsibilities include:

Claims Processing & Billing: Preparing and submitting medical claims for government-funded healthcare programs.
Regulatory Compliance: Ensuring all billing activities comply with federal regulations, such as HIPAA, Medicare/Medicaid guidelines, and TRICARE policies.
Accounts Receivable Management: Tracking payments, identifying discrepancies, and reconciling accounts with government agencies and contractors.
Insurance & Payment Coordination: Liaising with insurance providers and government payers to resolve disputes and ensure accurate reimbursements.
Financial Reporting & Audits: Maintaining accurate records and assisting with financial audits related to government healthcare contracts.

Medical Billing/Account Management Specialist Job Description

A Medical Billing/Account Management Specialist working on a government contract is responsible for handling medical claims, payment tracking, and compliance with government regulations. Their duties include:

Processing medical claims for government healthcare programs, ensuring timely and accurate submissions.
Reviewing claims for coding accuracy and compliance with federal guidelines.
Managing accounts receivable, tracking outstanding payments, and resolving discrepancies.
Communicating with insurance providers, healthcare facilities, and government agencies to facilitate payment processing.
Ensuring adherence to government regulations, including HIPAA, CMS guidelines, and TRICARE billing policies.

Job Requirements for a Medical Billing/Account Management Specialist

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES:

Proficiency in medical coding (CPT, ICD-10, HCPCS) and claims processing.
Strong knowledge of government healthcare billing regulations (Medicare, Medicaid, TRICARE).
Experience using electronic health records (EHR) and billing software such as Epic, Cerner, or Medisoft.
Excellent attention to detail for reviewing claims and ensuring compliance.
Strong analytical and problem-solving skills to resolve billing discrepancies.

EDUCATIONAL BACKGROUND AND EXPERIENCE:

Associate’s or Bachelor’s degree in Healthcare Administration, Medical Billing, Accounting, or a related field.
3+ years of experience in medical billing, claims processing, or healthcare account management.
Certified Professional Coder (CPC) or Certified Billing & Coding Specialist (CBCS) is preferred.
Experience with federal healthcare contracts or government insurance programs is a plus.

WORKSPACE/PHYSICAL REQUIREMENTS:

Primarily office-based or remote, depending on contract requirements.
May require occasional travel to healthcare facilities or government offices.
Ability to obtain a security clearance if handling sensitive government healthcare data.

What does a typical job posting look like for a Medical Billing/Account Management Specialist?

Job Title: Medical Billing/Account Management Specialist
Location: [Insert Location]
Security Clearance: [Insert Clearance Level, if required]

Job Summary:
We are seeking a Medical Billing/Account Management Specialist to support government healthcare contracts. The ideal candidate will have experience with medical claims processing, regulatory compliance, and financial account management for government-funded healthcare programs.

ESSENTIAL JOB FUNCTIONS:

Process and submit medical claims for government healthcare programs.
Review claims for accuracy and compliance with federal billing guidelines.
Manage accounts receivable and coordinate payments with government agencies and insurance providers.
Assist with financial reporting and audits to ensure billing integrity.
Stay updated on changes in healthcare regulations and government billing policies.

Salary Range

The salary for a Medical Billing/Account Management Specialist on government contracts typically ranges from $55,000 to $95,000 per year, depending on experience, location, and security clearance level.