Billing Specialist

• Support patients with payment processing, billing education, insurance verification, and claims-related inquiries.
• Deliver empathetic, accurate, and compliant service while navigating healthcare billing systems and policies.
• Perform all payment processing and payment plan functions in addition to advanced billing, insurance, and claims support.

Patient Billing Representative

• Ensure strict HIPAA-compliant confidentiality with all client data and claims
• Manage and operate in multiple different billing platforms dependent on client needs which could include Azalea, Tebra, Central Reach and/or Rethink Integrated Billing Module
• Manage assigned client accounts billing scrubs for primary and secondary claims
• Submit claims electronically for primary and secondary payors
• Solve clearinghouse rejections
• Submit corrected claims for billing errors, rebill projects (new plans/new year, new information on payor policies)
• Maintain account spreadsheets, billing cheat sheets, provider, and billing information including provider roster and payer policy billing rules
• Contribute to updates and communicate to Customer Billing Advocate and other members of POD
• Provide internal reporting to team of status and issues for clients within POD
• Meet internal benchmarks for clean claims / first pass rate, unbilled claims, clearinghouse rejections, secondary claims, and denials for billing errors
• Research specific payor billing rules as needed
• Review client billing documentation to ensure claims are submitted based on payor requirements
• Stay informed about Payor and Industry Billing rules
• Foster a positive work environment for team members

• Serve as a liaison with subscribers, groups, and agencies to answer eligibility, benefit, payment, and contract questions.
• Reconcile eligibility and enroll or terminate subscribers and dependents according to group contracts and underwriting guidelines and for the individual plan.
• Reconcile daily receipts and research variances.
• Apply receipts to outstanding invoices.
• Import electronic enrollment file and distribute discrepancy report to groups.
• Perform COBRA administration for designated groups according to federal regulations.
• Convert Excel electronic enrollment files and train other team members on the process.
• Provide support to other team members in the absence of supervisor or manager.
• Assist in training new members of the team.
• Liaison for IT for Eligibility projects and testing.
• Perform testing and support for IT changes.
• Demonstrate a commitment to the organization’s vision, mission, values, code of ethics, and compliance/security standards.
• Other duties as assigned.

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Patient Billing Representative

Billing Specialist

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