Billing Specialist

• Provide analytical support above and beyond the role of Epic System Analyst
• Mentor less experienced analysts across the department
• Facilitate project meetings and presentations to diverse audiences including project team through senior leadership.
• Lead/participate in multiple projects by completing and updating project documentation; managing project scope; adjusting schedules when necessary; determining daily priorities; ensuring efficient and on-time delivery of project tasks and milestones; follow proper escalation paths.
• Collaborates on decisions that refine and improve known practices or develops new approaches (researching and assess new technologies or functionalities).
• Maintain project documentation including meeting minutes and issue lists. Manage end-user relationships and expectations by developing documentation and communication processes to keep others up to date on project results.
• Communicate effectively with project stakeholders. Utilize formal and informal written communication methods to communicate updates and findings.
• Serves as a resource for other application team members on technical and functional application analysis, defining system requirements, and developing logical data models using best practices for build, configuration, maintenance, and data integrity.

Senior Epic Hospital Billing Analyst

• Review daily point-of-service (POS) pharmacy claims, resolve actionable items, track, and provide reporting
• Investigate and resolve pharmacy claim rejections, reversals, and payment discrepancies in real time
• Collaborate with external pharmacy and claims teams to ensure accurate claim adjudication and payment
• Submit and track claim overrides when appropriate and compliant with plan and CMS guidelines
• Facilitate the prior authorization process by working with prescribers, pharmacies, and internal clinical staff
• Monitor PA status and proactively communicate determinations and next steps to pharmacies and providers
• Serve as primary billing and claims contact for contracted network and long-term care pharmacies
• Communicate professionally with pharmacy billing teams, prescribers, and facility staff to resolve claims issues
• Educate pharmacies and provider offices on billing requirements, formulary limitations, and plan processes
• Support transitions of care by ensuring medication access and clean claim processing for new or discharged members
• Maintain compliance with CMS Medicare Part D regulations, HIPAA, and plan policies
• Accurately document all claim interventions, communications, and resolutions in the plan’s system
• Assist with internal audits, reporting, and quality improvement initiatives related to claims and billing
• Identify trends in claim rejections or PA delays and escalate systemic issues to leadership
• Monitor daily billing and claims work queues and meet productivity and turnaround time expectations
• Participate in cross-functional meetings with pharmacy operations, clinical, and provider relations teams
• Support process improvement initiatives to enhance claims efficiency and member access to medications
• Serve as a liaison with Enrollment Department to assure appropriate member eligibility processing
• Recognize formulary requirements: prior authorization (PA), Step Therapy (ST), Quantity Limit (QL) and understand NCPDP reject codes
• Coordinate clinical reporting
• Follow-up and solve open items in a timely manner
• May be assigned to work on special projects and business initiatives

Pharmacy/Billing Technician

• Supervises daily operations of SSC collections team.
• Assists the AR Manager in implementing and monitoring departmental policies and procedures including QA assessments on staff.
• Assists training team in developing training programs and materials for staff.
• Works with manager to draft team evaluations as well as participate in drafting and delivering disciplinary actions.
• Keeps informed on all current applicable third-party payer regulations, requirements, and state laws and guidelines.
• Informs management and other staff members of changes and keeps documentation current and accessible.
• Identifies any payer trends and resolves or escalates as appropriate.
• Supervises the effort to successfully reduce days in A/R and meets productivity goals.

Billing Supervisor

• 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

• Responsible for maintaining Revenue Cycle Services, and other departments with resolution of billing issues and/or denials requiring clinical expertise.
• Responsible for researching, working, and resolving claim denials and rejections in your assigned client.
• Assume ownership over your assigned clients for all aspects of the billing cycle, including Charges, Payments, and AR metrics and performance.
• Keep on task to meet all required deadlines and timeframes for customer and company needs.
• Assist in the development of processes and procedures for each assigned account.
• Monitors and analyzes current industry trends and issues for potential organizational impact.
• Communicate regularly with your assigned clients to alert them of trends identified and recommended resolutions.
• Collaborate with all departments to ensure billing accuracy and efficiency.
• Deliver timely required reports to the management team; initiates and communicates the resolution of issues, such as payer denial trends, collections accounts, inaccurate or incorrect charges.
• Ensure compliance with all relevant regulations, standards, and laws.
• Assist with any other projects as assigned by the Operations leadership.

• 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

• Assist with initiating and implementing of all aspects of the monthly client billing process including: Review and edit monthly proformas as instructed by the Billing Attorney via Paperless Proforma.
• Modify time and cost entries as directed.
• Write offs and write downs.
• Completing transfers, dividing, and combining timecards.
• Ensuring rates are accurate.
• Applying available funds to billing as instructed.
• Verify accuracy of billing.
• Compile supporting back-up documentation, per client billing guidelines as required.
• Acquire and maintain proper approval documentation.
• Finalize and distribute invoices in accordance with Firm and Client guidelines.
• Research and respond to billing inquiries from both attorneys and clients in a timely and professional manner.
• Submit invoices by mail, email, e-billing via eBillingHub and other e-billing vendors as required.
• Set up matters for e-billing on vendor sites and within the firm’s billing system.
• Address and resolve billing disputes and discrepancies in a timely manner.
• Coordinate appeals for rejected invoices.
• Provide client accruals, status updates and budgets upon request.
• Communicate with attorneys, clients, or staff to address billing questions, as needed.
• Maintain contact with attorneys, staff, and clients and observes confidentiality of client and firm matters.
• Answer questions regarding billing processes and procedures.
• Collaborate with other departments as needed for Accounts Receivable, client and matter setup, rate management, trust accounting, unallocated funds, and billed on account funds.
• Maintain addresses, invoices templates, and e-billing information within the firm’s billing system.
• Assist with customized reporting requirements for internal/external clients.
• Effectively prioritize numerous tasks and complete within designated time deadlines.
• Manage monthly reports surrounding billing workload.
• Other duties as assigned.

• Coordinate and audit electronic invoice submissions of the billing team.
• Ensure all e-billing procedures are being followed in an accurate and timely manner.
• Provide excellent customer service to internal and external customers; escalate any potential service delivery issues to the manager.
• Document and maintain e-billing vendor instructions and templates.
• Responsible for generating and reviewing monthly reports surrounding e-billing items to administer deadlines and maintain data that may require continuous follow up.
• Mentoring assigned Billing Specialists: Guidance with electronic billing setups in 3E Matter Maintenance, eBillingHub, and third party electronic billing vendor websites.
• Assistance with resolving invoice rejections and reductions.
• Maintain electronic billing application; monitor outstanding and rejected electronically billed invoices: Assist receivable team with appropriate reports and work with group to ensure timely response in resolution of short paid electronic invoices.
• Responsible for assisting with new client electronic billing setups.
• Client Billing: Assist with initiating and implementing of all aspects of the monthly client billing process including: Maintain telephone and personal contact with clients, attorneys and staff on billing matters Modify time and cost entries as directed Compile necessary back-up documentation per client billing guidelines Acquire and maintain proper approval documentation Print/mail or electronically submit client invoices.
• Utilize computerized accounting and billing software applications.
• Maintain contact with attorneys, staff, and clients and observes confidentiality of client and firm matters.
• Provide electronic billing education training as needed.
• Evaluate and recommend new process improvements.
• Perform special projects and other duties as assigned.
• Manage the day-to-day changes required to maintain accurate client information

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