Billing Specialist

Position Responsibilities may include, but not limited to

• Create billing reports of assigned agencies
• Submit accounts receivable claims and/or invoices for weekly/monthly billing of assigned agencies
• Reconciliation of assigned state or local agencies
• Research and resubmit of billings to assigned agencies
• Review quality assurance of all referrals or updated clients from assigned state or local agencies
• Make outbound & inbound calls, emails to assigned state or local agencies with the purpose of securing correct information regarding new referrals, updated clients, and billings
• Responsible for executing complex billing tasks, mentoring junior staff, and leading cross-functional initiatives
• Reduce payment agency backlog
• Perform in-depth audits of project data to identify and resolve billing discrepancies
• Demonstrate successful performance through accuracy, timeliness, and customer satisfaction metrics
• Utilize advanced Excel functions (e.g., VLOOKUP) and reporting tools in CRM and SharePoint
• Manage complex billing scenarios including denials, rejections, and aging accounts
• Collaborate with Posting teams to resolve discrepancies and support month-end close
• Prepare and submit electronic claims, paper claims, and invoices (CMS-1500, UBs, invoices, and payer portals, etc.)
• Resolve claim rejections timely and resolve claim denials through research, appeals, claim corrections/resubmission, and follow-up with health plans
• Ensure accurate and compliant billing, following specific regulations of multi-state Medicaid and MCO's, Medicare Advantage, and Older Americans Act programs
• Responsible for ensuring aged outstanding balances of assigned payers is kept within department standards
• Participate in process improvement initiatives. Collaborate across teams to resolve issues, claims denials, and aging
• Other tasks as assigned, including but not limited to, assisting with projects that impact collections or write offs

Required Skills and Experience

• High School Diploma or GED
• 2+ years of work-related experience in healthcare related field, ie, healthcare billing institutional and professional claims, patient registration, and/or patient access
• Intermediate level Excel skills
• Strong oral and written communication skills
• Ability to multi-task, set priorities, and pays close attention to detail
• Strong ability to work with team members across multiple departments
• Ability to work unsupervised with strong critical thinking and problem-solving skills       
• Experience with Waystar, CRM, D365, and/or electronic health record platforms
• Must have a wired internet connection using an ethernet port. Broadband internet wired to the home is required - Cable Modem/service or Fiber Optic. No Satellite, 4/5G, or DSL circuits
• Must have a quiet workspace that is free from distraction

Preferred Skills and Experience

• Bachelor's degree in healthcare administration, medical administrative assistance, or healthcare finance
• Previous experience with electronic claims, such as electronic 835/837 claim and remit files, Zirmed, and/or secure payer web portals
• AAHAM and/or HFMA certification
• Knowledge of CMS regulation and strong familiarity with healthcare billing standards and compliance
• Experience with Waystar, CRM, D365, and/or electronic health record platforms

Physical Requirements

• Repetitive motions that include the wrists, hands and/or fingers
• Sedentary work that primarily involves sitting, remaining in a stationary position for prolonged periods
• Visual perception to perform job including peripheral vision, depth perception, and the ability to adjust focus