Billing Specialist II

Overview

This remote Billing Specialist role supports the complete and timely collection of revenue by accurately coding and entering patient and charge information into the billing system. The specialist will track high dollar claims from charge entry through payment and resolve complex carrier issues, actively following up on outstanding claims and charges.

Candidates must reside in one of the following states: MD, DE, VA, NJ, PA, FL, AL, GA, SC, or TX.

Responsibilities

• Review and resolve complex payer denials, including appeals, coding corrections, and medical necessity issues.
• Assist auditors in reviewing notes for medical necessity.
• Collaborate with the authorization department to resolve authorization issues for complex procedures.
• Maintain tracking logs for complex high dollar procedures and report results to billing management.
• Contact Provider Service Representatives to resolve repetitive payment issues.
• Serve as a resource for billing staff on complex issues.
• Analyze and resolve billing issues, maintaining accounts receivable (A/R) at no more than 10% over 60 days.
• Process daily correspondence, claim status inquiries, denials, appeals, and re-bills.
• Respond to billing questions from patients and internal staff.
• Update patient files with changes to address and contact information.
• Regularly review policy changes and inform supervisors and charge entry specialists.
• Navigate insurance company websites to research policies and payments.
• Keep supervisors informed about accounts receivable matters.
• Respond promptly to requests from the billing company.
• Research denials and submit corrected claims and medical documentation.
• Manage claims within work dashboard hold buckets for resolution.
• Create, maintain, and update reports as directed.
• Maintain confidentiality and comply with HIPAA regulations.
• Assist in training new revenue cycle staff.
• Collect and review end-of-day reports.
• Monitor work email regularly throughout the day.
• Participate in required trainings and in-services.
• Perform other duties as assigned.

Minimum Qualifications

• High School Diploma or equivalent with at least five (5) years of related experience, or an equivalent combination of education and experience.
• Proficient with Internet and Microsoft Office software (Word, Excel, PowerPoint, Outlook).
• Excellent written and oral communication skills with strong customer service orientation.
• Ability to establish and maintain effective working relationships with doctors, clinical staff, coworkers, and the public.
• Capable of working independently and as part of a team.
• Ability to follow verbal and written instructions.
• Flexible schedule availability.
• Patience and understanding in stressful situations related to patient health.
• Strong multitasking, prioritization, and organizational skills.
• Extreme attention to detail.
• Problem-solving and reasoning abilities.
• Ability to meet predefined quality standards.
• Professional attitude and appearance at all times.
• Working knowledge of CPT and ICD-10 coding rules.
• Solid foundation of insurance knowledge and third-party payer guidelines.
• Familiarity with healthcare field, medical specialties, and medical terminology.

Preferred Qualifications

• Two (2) years of experience working with an Electronic Medical Record (EMR) system.
• Medical Billing Certification.

Driving/Travel

• Reliable transportation is required.
• Work assignments may be at any of the organization's locations, though the primary workplace will be near the employee’s home.

Compensation and Benefits

• Pay Range: $25.00 to $29.00 per hour
• Paid Time Off: Up to 96 hours in the first year (pro-rated based on start date)
• Holidays: 7 paid holidays (New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Day After Thanksgiving, Christmas Day)
• Retirement: 401(k) plan with employer match
• Health Benefits: Medical, Dental, and Vision coverage available for single and family plans
• Company-Paid Benefits: Short-Term Disability, Long-Term Disability, Basic Life/AD&D, Employee Assistance Program
• Voluntary Benefits: Voluntary Life, Accident, Critical Illness, Hospital Indemnity

Location

Remote position; candidates must reside in MD, DE, VA, NJ, PA, FL, AL, GA, SC, or TX.