Billing Specialist

Overview

A health plan solutions organization is seeking a Billing Specialist to join their team remotely. This role is responsible for the accurate, timely, and compliant generation of client premium billing. The Billing Specialist acts as a key liaison between operational teams and clients to ensure billing activities reflect current eligibility, plan configurations, rates, and client expectations.

Responsibilities

• Manage monthly premium billing for an assigned portfolio of client groups, ensuring invoices are accurate and delivered on schedule.
• Create, review, and release monthly premium bills applying established billing methodologies, fee structures, and client-specific requirements.
• Review billing details for inconsistencies, discrepancies, or missing information and investigate errors prior to invoice distribution.
• Verify fees, rates, and administrative charges against approved documentation and contractual requirements.
• Ensure annual renewals, mid-year rate changes, and new group implementations are accurately reflected on invoices.
• Update billing calculations for rate changes, renewals, and client modifications.
• Coordinate with Configuration, Eligibility, Finance, and Client Banking teams to resolve rate discrepancies.
• Confirm billing data aligns with approved client setups and system configurations.
• Maintain documentation and records following company standards, ensuring audit-ready files for billing transactions, rate changes, and client communications.
• Respond professionally and promptly to client billing inquiries.
• Collaborate with Client Experience, Member Experience, Eligibility, Finance, Configuration, and Banking teams to resolve billing issues.
• Research invoicing concerns and provide clear explanations regarding charges, adjustments, and billing calculations.
• Communicate effectively with clients, brokers, and internal stakeholders at various organizational levels.
• Monitor production reports and performance metrics, meeting assigned billing volume and turnaround expectations.
• Maintain established quality audit scores and respond to audit findings within required timeframes.
• Implement corrective actions to improve billing processes and quality.

Requirements

• High School Diploma or GED.
• Experience interpreting large data sets and identifying discrepancies.
• Strong mathematical and reconciliation skills.
• Advanced Microsoft Excel skills, including data manipulation, validation, and reporting.
• Proficiency with Microsoft Lists and related Microsoft Office applications (Word, PowerPoint, Visio, Copilot).
• Ability to navigate billing and operational systems efficiently.
• Strong verbal and written communication skills with the ability to explain complex billing concepts.
• Professional customer service approach when handling escalated billing concerns.
• Comfortable interacting with clients, brokers, and operational departments.
• Effective time-management and prioritization skills.
• High level of accuracy, attention to detail, and strong organizational and documentation skills.
• Ability to follow HIPAA guidelines and protect confidential member information.
• Adherence to established billing processes, operational procedures, and company standards for quality, documentation, and client service.
• Willingness to participate in team meetings, training sessions, quality reviews, and continuous improvement initiatives.

Compensation & Benefits

• Multiple health plan options.
• Company-paid employee premiums for disability and life insurance.
• Parental leave policy.
• 20 days paid time off to start plus 10 paid holidays.
• Tuition reimbursement.
• 401(k) company contribution.
• Company-paid short and long-term disability plus life insurance.
• Professional development initiatives and continuous learning opportunities.
• Opportunities to participate in and support diversity and inclusion initiatives.

Location

• This position is 100% remote.

Equal Opportunity

The employer is an equal opportunity organization. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.