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 an opportunity to help build billing processes from the ground up, establish best practices, and identify opportunities for continuous improvement.
Key Responsibilities
- 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 on time.
- 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.
- 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.
- 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.
Education and Experience
- Minimum of 2 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 and sound judgment.
- Strong communication and interpersonal skills.
- Understanding of general business and office terminology.
- Intermediate computer skills.
- Ability to work within a team and support other team members as needed.
- Ability to compose routine correspondence and reports.
Location
Michigan, US
Employment Type
Full-time
Experience Level
Associate
Salary Range
$58,000 - $60,000
Remote work allowed
Yes
Posted
3 weeks ago