Billing Specialist

About the role

As a Billing Specialist you’ll secure revenue by ensuring timely payment of claims by insurance companies, resolving both initial rejections as well as processing errors by Avance Care payer partners and clearinghouses. You’ll also ensure maximum reimbursement to the organization by timely follow‑up on all claims and having the necessary functions to bill, collect, analyze, and adjudicate billing functions for all clinical services.

Responsibilities

• Oversee the Claim Cycle to resolution, ensuring efficiency and accuracy
• Reviews and resolves front end rejections in Clearinghouse and Billing Software
• Research, address, and resolves all payer claim denials, account discrepancies and payment variances
• Contact appropriate party regarding claims denial via outbound calls, insurance portals, fax, or email to ensure final resolution
• Re‑file or bill to patient as appropriate
• Address and resolve incoming phone calls from insurance companies regarding claim denials or processing
• Research and collect information to submit appeals; follow‑up on all billing related appeals
• Provide Medical Records and supporting documents to various insurance company websites to assist with claim resolutions
• Process insurance refunds and reconcile patient accounts in billing system
• Process patient payments over the phone, post payments to appropriate accounts and provide receipts
• Collaborate with Payments/Collections Team and Outsource Call Center associates regarding patient inquiries
• Collaborate with Coding Team regarding discrepancies for claim denials
• Aid Practice locations regarding account, insurance, or billing process inquiries
• Complete audit for AR work performed by Outsource associates

Requirements

• High School Diploma, or post‑secondary certificates in a related field (preferred)
• 1‑2 years of related billing experience (preferred)

Qualifications

• Strong verbal and written communication
• Knowledge of insurance practices
• Payer policy research and analysis skills (preferred)
• Denial analysis and trending skills (preferred)
• Knowledge of the HCFA 1500 claim form (preferred)

Benefits

We offer a comprehensive benefits package available on the first of the month following 30 days of employment.

Schedule

This is a full‑time role involving 8‑hour weekday shifts with no weekend schedule. The position works a hybrid schedule with 4 days remote and 1 day onsite.