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 escape 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. Requirements 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) Salary Description $27.00 - $35.00 an hour #J-18808-Ljbffr