FT or PT Hybrid Med Billing Specialist

**Role Overview** **No Nights, Weekends, Holidays** We are seeking a dedicated Medical Billing Specialist to serve in a dual\-function role at our WI facility. You will serve as the on\-site point of contact for our Medicare 855B site inspection process and support our Care Management Billing team. This position is currently 5 days per week, on\-site at 444 Reid Street, De Pere, WI 54115\. As our clinical program scales and staffing grows, a hybrid schedule (rotating in\-office and remote days) will become available. That transition will be communicated in advance with clear expectations. **Physical presence during the 10:00 AM to 2:00 PM \- Monday through Friday (FT or Multiple PT to cover).** Our facility is subject to unannounced CMS / MAC site inspections as part of a pending 855B application. A missed inspection results in automatic application denial. Punctuality and consistency are non\-negotiable in this role. **On\-Site Responsibilities** **Medicare Site Inspection Compliance** * Serve as the sole dedicated physical presence at the facility during all posted operating hours. * Act as the immediate, professional point of contact when a MAC field inspector arrives unannounced. * Escort inspectors through the facility and respond to operational questions factually and without elaboration. * Confirm each morning that the facility is open, utilities are operational, and equipment is functioning before 10:00 AM. * Verify that external business signage is visible and in compliance. * Maintain strict physical HIPAA compliance, including locked medical records storage and secured server areas. * Maintain the Readiness Binder at the front desk at all times, containing: * Active state facility licenses * IRS CP\-575 forms * Current building lease * Copy of the submitted 855B application **Medical Billing Specialist – Care Management** The Medical Billing Specialist supports the day\-to\-day revenue cycle operations for Medicare and commercial care management programs, including Chronic Care Management (CCM), Principal Care Management (PCM), and Remote Patient Monitoring (RTM). This role is responsible for accurate data entry, claim reconciliation, billing support, and identifying claim or documentation issues to ensure timely and compliant reimbursement for our provider partners. This position works closely with internal operations, compliance, customer success, and provider offices to resolve billing issues, reconcile claims, and support revenue cycle performance. Primary Responsibilities * Perform accurate data entry of care management encounters and billing information. * Reconcile monthly care management services prior to claim submission. * Review billing reports to identify missing documentation, coding discrepancies, and claim variances. * Research denied, rejected, or unpaid claims and assist with resolution. * Perform detailed claim analysis and revenue cycle "deep dives" to identify trends and opportunities for process improv