Sr. Medical Billing & Collections Specialist

The Sr. Billing & Collections Specialist is responsible for ensuring accurate and timely billing, proactive collections, and consistent follow-up on outstanding accounts to support the financial health of the organization. This role works to secure prompt reimbursement from patients and third-party payers, resolve billing issues and claim denials efficiently, maintain account accuracy, and uphold compliance and confidentiality standards while collaborating with internal teams and families.

Compensation: $27.00 - $35.00 an hour

Schedule: Monday - Friday, 8am-5pm, in accordance with Company needs

This is an on-site position. No remote work is available.

Responsibilities:

• Promote and maintain a positive and professional reputation for the Billing Department through effective, timely communication with patients, families, internal staff, and third-party payers.
• Manage assigned accounts accurately, ethically, and in accordance with company standards, policies, and procedures.
• Bill patient services to patients and third-party payers on a daily basis with accuracy and timeliness.
• Monitor outstanding balances and follow up consistently to prevent delays in reimbursement and account resolution.
• Collect all patient financial responsibility, including current and past-due balances, in accordance with Company policy.
• Contact patients or parents regarding unpaid balances, denied claims, non-covered services, or other billing issues requiring resolution.
• Establish and track payment arrangements with patients or families and follow up promptly when payment arrangements lapse.
• Follow up on delinquent accounts on a routine basis and escalate concerns as appropriate.
• In accordance with Company policy, perform timely and aggressive follow-up on outstanding claims, meticulously resolve denials by correcting errors, gathering necessary documentation, and resubmitting claims efficiently.
• Consistently and persistently follow up on unpaid insurance claims, with the goal of resolving payment issues within 30 days.
• Notify leadership of unresolved claim issues, delayed payments, or accounts exceeding established follow-up timelines.
• Remove patients from the schedule in accordance with Company policy, when insurance or patient payment issues arise.
• Report collection-related concerns and high-risk accounts to the Administrative Director and CEO every week.
• Discuss potential write-offs with the Administrative Director and obtain approval prior to finalizing any adjustment.
• Secure payments by obtaining and maintaining accurate billing, insurance, and patient account information. Generate and send monthly account statements on time, as needed.
• Conduct insurance verification, as needed.
• Oversee service authorizations to ensure timely requests, approvals, and billing readiness.
• Create and maintain follow-up reminders for patient and insurance communications to support timely account resolution.
• Educate providers regarding billing requirements, payer updates, and coding changes that affect claims submission and reimbursement.
• Provide training or guidance to staff regarding billing practices, documentation requirements, and compliance, to ensure billing accuracy.
• Communicate billing errors to providers and assist in resolving documentation or coding issues that impact payment.
• Ensure that all billing, collections, and patient financial information is handled confidentially and in compliance with applicable regulations.
• Respond to employee and client billing-related emails and inquiries within 48 hours.
• Stay updated on changes in medical coding and billing standards, insurance policies, and billing regulations to ensure ongoing compliance.
• Support implementation of new billing systems or updates in collaboration with EMR systems and Clearing House.
• Conduct routine audits to ensure compliance with all regulatory and internal billing standards, and all procedures are billed and documented properly.
• Maintain compliance with professional standards, organizational policies, and all applicable federal, state, and local requirements.
• Proactively identify, report, and collaborate on solutions for problematic issues impacting team duties, efficiency, or compliance, to ensure revenue flow remains steady and consistent.

• At least 5+ years of billing and collections experience.
• Experience with Raintree EMR system and Availity.
• Must be available to work flexible schedules including weekends, evening, and holidays.
• Ability to solve problems by finding creative solutions and following through.
• Demonstrate a positive attitude, professional conversational skills, and enjoy working with families and patients.
• Ability to work independently and within a team.
• Ability to handle multiple tasks simultaneously and manage one's own time appropriately.
• Able to engage families in a clear and professional manner.
• Demonstrate the ability to act in a professional manner and maintain competency in a fast-paced work environment.
• Proficient in the use of MSWord, Excel, PowerPoint, Outlook, and Raintree.
• Excellent written and verbal communication skills and the ability to use discretion regarding confidential matters.
• Ability to multitask and operate in a loud, busy environment.
• Ability to work well under pressure and meet deadlines, goals, and targets.
• Demonstrate sound judgement making skills.
• Ability to work in a high paced work environment, while maintaining attention to detail and a high level of accuracy.
• Demonstrate a high level of resiliency by being flexible and adapting to changes quickly.
• Demonstrate enthusiasm about the Company’s mission, the role, and enjoy working in pediatrics.
• Continuously working towards advancing skillsets.
• Ability and willingness to sit or stand at a desk for long periods of time.
• Intermittently twist to reach equipment or supplies surrounding desk.
• Use a telephone and computer keyboard on a daily basis.
• Requires standing/walking/reaching and bending throughout shift.
• Ability and willingness to lift, lower, push, carry, or pull up to 40-50 lbs. on an as needed basis.
• Ability to maintain patient confidentiality as per HIPPA Compliance. (Health Insurance Portability & Accountability Act of 1996)