The Billing Specialist II is responsible for advanced billing functions, including comprehensive claim review and submission, managing complex cases, and ensuring compliance with detailed payer requirements. This role also supports training of junior billing staff, participates in audits, and assists in refining processes to support accurate reimbursement and compliance.
Essential Duties and Responsibilities
- Verify patient demographic and insurance data, including complex or non-standard cases.
- Prepare, review, and submit electronic and paper claims to a variety of payers and government programs.
- Identify and resolve standard and complex claim rejections.
- Maintain current knowledge of internal billing protocols, coding updates, and payer-specific requirements.
- Enter and review census data from multiple facilities in Monday.com and billing platforms.
- Follow established billing procedures and escalate irregular issues as needed.
- Provide guidance to entry-level billing specialists to support team operations.
- Participate in internal audits and recommend adjustments to billing policies and workflows.
- Maintain compliance with HIPAA and data privacy regulations.
- Manage multiple assignments with a focus on quality and completion within required timeframes.
Requirements & Qualifications
Minimum Qualifications
- High school diploma or equivalent; some work history may be substituted if necessary.
- Proven interpersonal skills with the ability to interface effectively both internally and externally with a wide range of people, including insurance companies, office staff, facility operators, and other staff as needed.
Key Competencies
- Proven reliability when adapting to new experiences.
- Ability to follow standard operating procedures.
- Solid understanding of insurance policies, claims, or payment remittance from payers; if no current understanding exists at hire, the ability to learn quickly is expected.
- Ability to multitask and manage time effectively without consistent oversight.
- Excellent written and verbal communication skills.
- Ability to remain organized and delegate/complete tasks in a first-in, first-out manner.
Benefits & Perks
Benefits Include
- Medical, dental, vision, and life insurance
- Employee Assistance Program
- 401(k) match
- Paid time off
- Sick time
- Holiday pay
Location
Georgia, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago