Billing Specialist

Job Description

Job Description

Description:

PRINCIPAL SUMMARY:

The Billing Specialist is responsible for the accurate and timely billing of services to third-party payers, including managed care organizations (MCOs), commercial insurance plans, Medicaid, and other funding sources. This role supports the revenue cycle by ensuring claims are submitted accurately, resolving billing discrepancies, managing accounts receivable activities, and maintaining payer compliance.

As part of a newly acquired line of business, this position offers a unique opportunity to help build billing processes from the ground up, establish best practices, and identify opportunities for continuous improvement. The ideal candidate is proactive, analytical, and energized by creating efficient, scalable processes within a growing organization.

ESSENTIAL FUNCTIONS

Billing and Revenue Cycle Management

• Prepare, review, and submit claims and invoices to third-party payers according to payer-specific requirements and deadlines. 
• Monitor billing activity and ensure claims are submitted accurately and timely. 
• Research, resolve, and resubmit denied, rejected, or unpaid claims. 
• Review remittance advice and payment activity to identify discrepancies and underpayments. 
• Collaborate with operational and clinical teams to resolve billing issues and obtain missing documentation. 
• Maintain documentation supporting claim submissions, adjustments, appeals, and payer communications. 
• Ensure compliance with payer contracts, regulations, and company policies.

Accounts Receivable

• Monitor and manage accounts receivable balances for assigned payers. 
• Investigate outstanding claims and initiate follow-up activities to obtain payment. 
• Reconcile payments, adjustments, and account balances. 
• Maintain accurate aging reports and identify collection risks. 
• Escalate recurring payer issues and support resolution efforts. 
• Assist with month-end reporting and revenue cycle reconciliations.

Process Development and Continuous Improvement

• Assist in developing and implementing billing processes and workflows for a newly acquired line of business.
• Document standard operating procedures and payer requirements.
• Evaluate existing workflows and identify opportunities to improve efficiency, accuracy, and cash collections.
• Participate in acquisition integration activities, system enhancements, and process improvement initiatives.
• Recommend process changes that support scalability and operational excellence.
• Collaborate with leadership to establish best practices and performance standards for the billing function.

OTHER DUTIES

• Other projects and activities as assigned.

SUPERVISORY RESPONSIBILITY

• No supervisory responsibility.

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS  

• Duties are performed using a hybrid working model combining remote work with office work. The needs of the business will determine the week-by-week structure.
• Ability to sit for extended periods of time and possesses the normal range of body motion.

Requirements:

EDUCATION AND/OR EXPERIENCE

• Minimum two years of billing, accounts receivable, revenue cycle, or healthcare reimbursement experience. 
• Experience billing third-party payers such as Medicaid, Medicare, managed care organizations (MCOs), commercial insurance carriers, or other healthcare funding sources required. 
• Experience researching and resolving denied, rejected, or underpaid claims preferred. 
• Experience in healthcare, behavioral health, home health, therapy services, or related healthcare settings preferred. 
• Experience supporting process improvement initiatives, new service lines, or acquisition integrations is a plus.

KNOWLEDGE AND SKILLS

• Demonstrates critical thinking by exhibiting sound and accurate judgement and includes the appropriate people in decision making.
• Exhibits effective communication and interpersonal skills including the four quadrants of Emotional Intelligence: self-awareness, self-management, social awareness, and relationship management.
• Exhibit an understanding of general business, office terminology and intermediate computer skills.
• Ability to work within a team, sharing & supporting other team members responsibilities where needed.
• Must be able to compose routine correspondence and reports.